There is no PE.
Our patient had dependent layering of contrast in the inferior vena cava which is a sign of cardiogenic shock. This also occurs if a patient arrests during a CT and involves not only the IVC but the major tributaries of the hepatic veins.
Indeed, our patient had cardiogenic shock along with an acute occlusion of the R common femoral vein. She had a heart rate of 40 with complete heart block n the ED and a transvenous pacemaker was floated. The patient was taken to the OR for her ischemic leg and then to the cath lab where she was noted to have a right coronary occlusion and RV failure. A right ventricular assist device was placed. Interestingly, the pacemaker placed correctly in the ED became completely entangled in the RV assist device.
In spite of milrinone, vasopressin , norepinephrine and a right ventricular assist device, the patient could not maintain her BP and expired.
An addendum was made to the original CT done in the ED stating the R coronary was occluded. Her initial trop had been normal and peaked at 30.
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Tsai PP, chen JG, Huang JL, Shen WC. Dependent pooling : a contrast-enhanced sign of cardiac arrest during CT. AJR. 2002;178:1095-99.
Jana M, Gamnagatti SR, Kumar A. Case series: CT scan in cardiac arrest and imminent cardiogenic shock. Indian J Radiol Imaging. 2010;20:150-53.