42-year-old male with acute pleuritic chest pain, tachycardia, and dyspnea. Elevated D-dimer. CT pulmonary angiography to evaluate for pulmonary embolism.

None available.

Axial helical CT images of the chest were obtained during peak pulmonary arterial enhancement following intravenous administration of 80 mL Omnipaque 350 via 18-gauge antecubital access. Sagittal and coronal reformations were generated.

Filling defects are identified within subsegmental branches of the right middle lobe and right lower lobe pulmonary arteries, compatible with acute pulmonary emboli. No filling defect in the main, lobar, or segmental pulmonary arteries. The main pulmonary artery measures 28 mm. No right heart strain by septal flattening or RV/LV ratio.

A 9 mm spiculated solid nodule is present in the apical posterior segment of the right upper lobe (image 22, series 4). Margins are irregular and spiculated. No additional pulmonary nodules. Otherwise the lungs are clear without consolidation, ground-glass opacity, or pneumothorax.

Trace right pleural effusion, likely reactive. No pneumothorax.

No lymphadenopathy by size criteria; largest mediastinal lymph node measures 9 mm in short axis. No mass.

Normal in size. No pericardial effusion. Coronary artery calcifications are not appreciated.

Heterogeneous appearance. No discrete nodule by size criteria on this non-dedicated study.

No suspicious lesion. Mild thoracic spine degenerative change.

UPPER ABDOMEN (PARTIALLY IMAGED): Unremarkable.

1. Acute subsegmental pulmonary emboli involving right middle and right lower lobe arteries. No evidence of right heart strain. 2. 9 mm spiculated solid pulmonary nodule in the right upper lobe apical posterior segment. Spiculation raises suspicion for primary lung malignancy. Recommend dedicated contrast-enhanced chest CT with thin-section reconstruction and PET-CT for further evaluation. Pulmonary nodule clinic referral suggested. 3. Trace right pleural effusion, likely reactive to PE.