Saddle pulmonary embolism with right heart strain and incidental detection of aortic-origin splenic artery and dual renal arteries on CT angiography.

Authors

Srikanth Nalla, Pravin Sudhakar Patil, Sumavally Maydari

Published in

Radiology case reports. Volume 21. Issue 10. Pages 4272-4275. Epub Jul 04, 2026.

Abstract

CT pulmonary angiography (CTPA) is the imaging modality of choice for diagnosing acute pulmonary embolism and simultaneously provides detailed assessment of thoracoabdominal vascular anatomy. Recognition of incidental vascular variants is important because these findings may influence future surgical and endovascular procedures. This case highlights the importance of systematic evaluation of all vascular structures on CTPA, even in emergency settings. A 52-year-old man presented with acute chest pain and progressive dyspnea. CT pulmonary angiography demonstrated a large saddle pulmonary embolism extending into the bilateral main pulmonary arteries and segmental branches. Secondary signs of right ventricular strain were present, including right ventricular enlargement (RV/LV ratio 1.55) and leftward bowing of the interventricular septum. Incidentally, CT angiography revealed direct aortic origin of the splenic artery and dual right renal arteries consisting of a hilar artery and an inferior polar artery. The patient underwent catheter-directed thrombolysis followed by anticoagulation therapy, with subsequent clinical improvement. This case highlights the value of comprehensive CT angiographic evaluation in acute pulmonary embolism. In addition to establishing the diagnosis and demonstrating right heart strain, CT identified clinically relevant vascular variants that may have implications for future abdominal surgery, endovascular interventions, and renal transplantation. CT pulmonary angiography plays a dual role by facilitating diagnosis and risk stratification of acute pulmonary embolism while simultaneously identifying clinically significant vascular variants that may influence future patient management.

PMID:
42437156
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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