{
  "abstract": "A woman in her 70s presented with acute fever and dyspnoea. Her medical history included lung cancer, interstitial pneumonia, autoimmune hepatitis and hypertension. She had been diagnosed with adenocarcinoma of the lung, stage T4N2M1a, for which she had undergone four courses of chemotherapy. A contrast-enhanced CT performed 8 months previously suggested tumour invasion of the left pulmonary artery. Her medications included cilostazol (200 mg/day) and prednisolone (5 mg/day). Physical examination revealed a temperature of 38°C, a pulse rate of 163 beats/min, blood pressure of 76/47 mm Hg, and oxygen saturation of 88% (breathing ambient air). An echocardiogram showed a right ventricular diameter of 43.6 mm, with hypokinesis of the free wall and normal apical contraction, tricuspid annular plane systolic excursion of 12.3 mm, and ventricular septum flattening, indicating right ventricular dysfunction. These findings suggested pulmonary thrombosis or pulmonary embolism (PE). The patient’s vital signs stabilised with oxygen supplementation and a 300-mL intravenous saline infusion. A chest CT was performed to investigate the cause of the symptoms. Non-contrast CT (WL/WW: 40/40) revealed a hyperdensity in the pulmonary artery ( figure 1). Subsequent contrast-enhanced CT confirmed a contrast defect in the pulmonary artery (figure 2), and the patient was diagnosed with cancer-associated pulmonary thrombosis. The CT showed no evidence of tumour progression or other findings such as pneumonia that could explain the patient’s symptoms. The patient’s vital signs stabilised, and a cardiologist assessed the thrombus as being of limited size. The patient was treated with rivaroxaban (because low-molecular-weight heparin is not available for venous thromboembolism in Japan).",
  "authors": [
    {
      "affiliations": [
        "Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan",
        "Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan"
      ],
      "name": "Yusuke Kimura"
    },
    {
      "affiliations": [
        "Department of General Medicine, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan",
        "Department of General Medicine, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan"
      ],
      "name": "Kosuke Ishizuka"
    },
    {
      "affiliations": [
        "Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan",
        "Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan"
      ],
      "name": "Kenya Ie"
    },
    {
      "affiliations": [
        "Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan",
        "Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan"
      ],
      "name": "Chiaki Okuse"
    }
  ],
  "title": "Non-contrast CT of pulmonary embolus",
  "uid": "21dad88b-3040-5fd7-8146-d7e0890607a6"
}