76 year old female with chest pain

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Multiple filling defects are seen within the the bilateral main pulmonary arteries and segmental arteries. There is enlargement of the right atrium and ventricle and straightening of the interventricular septum.

A wedge shaped region of hypoenhancement is seen in the left kidney.

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Filling defects in the pulmonary arteries represent pulmonary emboli, which are large and central enough to be causing pulmonary arterial hypertension and right heart strain.

The wedge shaped hypoenhancement in the left kidney is highly suspicious for renal infarct. Given the pulmonary emboli, this could suggest the presence of an atrial septal defect and paradoxical embolism. If an ASD is present, this patient would be at high risk for stroke, if not already present.

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