Two days after a pulmonary sleeve resection, the patient presents with a sudden onset of hypotension, hypoxia, and tachycardia. The chest radiograph reveals diminished pulmonary markings in the area of resection. What is the most likely diagnosis?
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After sleeve resections, early complications include dehiscence, acute respiratory distress syndrome (ARDS), or pulmonary artery thrombosis.
Since chest x-ray is clear with diminished markings, one has to rule out pulmonary artery thrombosis.
One cannot distinguish pulmonary artery thrombosis from pulmonary artery embolism by imaging alone, although known deep vein thrombosis or multiple areas of involvement favor the latter while the clinical history here favors the former.
Non-cardiogenic pulmonary edema and early ARDS would show areas of air-space disease, not areas of diminished vascularity.
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