SVC thrombus, pulmonary embolism and myocardial infarction in LAD territory

Case contributed by Stefan Tigges
Diagnosis certain

Presentation

Follow up for known metastatic small bowel carcinoma.

Patient Data

Age: 60 years
Gender: Female

Central line in the SVC with adherent thrombus. Pulmonary embolism right interlobar artery. Decreased attenuation interventricular septum and left ventricular apex in the distribution of the left anterior descending artery. Multiple liver metastases, no intrathoracic metastases.

Case Discussion

This case illustrates the need to keep looking even if you find one, two or even three abnormalities. The metastases to the liver are easy to spot, but in addition, the patient had SVC thrombus, pulmonary embolism and findings of ischemia in the distribution of the LAD with distal LAD occlusion shown on subsequent coronary catheterization. Remarkably, the patient was asymptomatic.

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