Diagnosing acute sub-massive pulmonary thromboembolism on non-contrast magnetic resonance imaging in a patient with single kidney and renal dysfunction

A 69 year old male patient, who had left nephrectomy, presented with sudden onset of chest pain and shortness of breath. His electrocardiogram and echocardiogram suggested acute pulmonary thromboembolism with right ventricular (RV) dysfunction. His creatinine was elevated. As he was considered a high risk candidate for CT pulmonary angiogram (CTPA), a magnetic resonance (MR) pulmonary angiogram was done which confirmed thromboembolism involving bilateral main pulmonary arteries, causing partial obstruction and extending into lobar and segmental branches. He was successfully thrombolysed and was started on apixaban. This case study is presented to stress the importance of emergency Non-contrast MR pulmonary angiography as an alternative diagnostic tool in selected cases with poor renal function where CTPA is contraindicated.