A 77-year-old male patient with a history of metastatic prostate adenocarcinoma (a Gleason score of 9) presented to the emergency department complaining of abdominal pain and fever. The initial examination showed no abdominal rigidity, and pulmonary auscultation was normal. However, the attending physician suspected dyspnea, despite an SpO2 of 96% on room air. Initial laboratory test results showed no definite signs of infection or anemia. Unenhanced abdominal and chest CT scans showed a typical postprostatectomy appearance and no acute findings in the upper abdomen or pelvis, with no consolidation or pleural effusion in the lungs. Nevertheless, hyperdense material was seen within the right and left pulmonary arteries, and the right ventricle appeared increased. The attending physician was notified, thus ensuring the clinical stability of the patient, who then underwent CT pulmonary angiography and echocardiography. A diagnosis of acute pulmonary embolism with right heart strain was established. In the context of pulmonary embolism, high attenuation in the main pulmonary arteries has shown variable and moderate sensitivity and specificity for acute pulmonary embolism in central pulmonary arteries,(1,2) with 100% specificity in a study by Chien et al., performing better than the Wells score.(3) 

 
AUTHOR CONTRIBUTIONS
 
APZ, RDG, and RRR: conceptualization, data curation, validation, visualization, writing of the original draft, reviewing, and editing. APZ: supervision.
 
CONFLICTS OF INTEREST
 
None declared.
 
REFERENCES
 
1.           Kanne JP, Gotway MB, Thoongsuwan N, Stern EJ. Six cases of acute central pulmonary embolism revealed on unenhanced multidetector CT of the chest. AJR Am J Roentgenol. 2003;180(6):1661-1664. https://doi.org/10.2214/ajr.180.6.1801661
2.           Torres PPTES, Rabahi MF, Mançano AD, Santos SHRD, Marchiori E. Frequency of spontaneous detection of pulmonary arterial thrombi in unenhanced chest computed tomography in patients diagnosed with pulmonary embolism. J Bras Pneumol. 2022;48(1):e20210128. https://doi.org/10.36416/1806-3756/e20210128
3.           Chien CH, Shih FC, Chen CY, Chen CH, Wu WL, Mak CW. Unenhanced mul-tidetector computed tomography findings in acute central pulmonary em-bolism. BMC Med Imaging. 2019;19(1):65. https://doi.org/10.1186/s12880-019-0364-y