On a CT pulmonary angiogram, the right/left ventricular diameter ratio is measured at 1.4 on axial images, the interventricular septum bows to the left, and there is reflux of contrast into the inferior vena cava and hepatic veins. These findings indicate:

• A Pericardial effusion with tamponade
• B Right heart strain / acute cor pulmonale from massive PE ✓
• C Left ventricular failure
• D Tricuspid regurgitation

Explanation

RV:LV ratio >0.9 on CTPA, septal bowing to the left (D-sign), and contrast reflux into the IVC/hepatic veins collectively indicate acute right heart strain from massive pulmonary embolism (cor pulmonale). These markers correlate with adverse outcomes and may prompt systemic thrombolysis. LV failure causes pulmonary oedema, not RV dilation. Pericardial tamponade shows pericardial fluid compressing the right chambers.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.