Diagnosis: Multiple pulmonary emboli (acute on chronic) asymptomatic

History: 65 year old woman with a history of coronary artery disease presents for a routine follow up. She denies any symptoms of chest pain, shortness of breath, or leg pain.

Findings: • Aneurysm of Ascending aorta (cm): 4.1 diameter ( unchanged) • Multiple acute on chronic pulmonary emboli (filling defects on CT) with minimally enlarged main pulmonary artery measuring up to 3.0 cm. • Small patent foramen ovale • Stable ascending aorta aneurysm. • Multiple pulmonary nodules as detailed above. Pulmonary nodule in left lower lobe is nonspecific and could represent pulmonary infarct in the setting of pulmonary emboli. Recommend non contrast CT chest in 6 months for further evaluation.

Ddx: • Pulmonary emboli • Multiple pulmonary nodules • nonspecific nodule in lower lobe may represent pulmonary infarct in setting of pulmonary emboli • aneurysmal dilatation of ascending aorta

Dxhow: Cardiac gated CT

Exam: Well developed, well nourished appropriate to stated age. Regular rate and rhythm, II/VI decrescendo diastolic murmur best appreciated over left upper sternal border. No JVD, 2+ peripheral pulses U/LE bilaterally. No carotid/abdominal bruits. Lungs are clear to auscultation bilaterally.