Ongoing shortness of breath and chest pain. ?Pneumonia ?PE.

CT pulmonary angiogram.

Good opacification of the pulmonary arteries.

There are obstructive chronic emboli within the left upper and lower lobe subsegmental pulmonary arteries. Further chronic emboli are seen within the right upper, middle and lower lobe segmental pulmonary arteries.

Acute pulmonary emboli are present within the left lower lobe segmental arteries.

Patchy mosaic perfusion pattern within both lungs. Small right pleural effusion.

Features of right heart strain with flattening of the interventricular septum and contrast reflux into the IVC. Normal calibre of the pulmonary trunk.

Mild coronary artery calcification. No mediastinal lymphadenopathy.

No acute rib fracture.

1. Acute on chronic pulmonary embolic disease, with acute pulmonary emboli in the left lower lobe segmental arteries and chronic emboli bilaterally.

2. CT features of right heart strain.

3. Patchy mosaic perfusion pattern within both lungs.

4. Small right pleural effusion.

5. Mild coronary artery calcification.