case_images: PMC5299177_01
case_images: Electrocardiogram showing sinus tachycardia and right ventricular strain pattern S1Q3T3 (deep S wave in lead I, Q wave in lead III, and inverted T wave in lead III).
case_images: CRIC2017-6752709.001.jpg
case_images: PMC5299177_01_CRIC2017-6752709.001.jpg
case_images: fig1
case_images: Laboratory results (Table 1) showed significantly elevated D-dimer and electrocardiogram showed sinus tachycardia with S1Q3T3 pattern (Figure 1). Echocardiogram (Figures 3 and 4 and Video 1 in Supplementary Material available online at https://doi.org/10.1155/2017/6752709) that morning remarkably displayed whirling echogenic mass in the atria and McConnell's sign.
case_images: CT pulmonary angiogram revealed a saddle embolus extending into the main, lobar, and segmental pulmonary arterial branches bilaterally with massive clot burden and near complete occlusion of the right main and branch pulmonary arteries.
case_images: CRIC2017-6752709.002.jpg
case_images: PMC5299177_01_CRIC2017-6752709.002.jpg
case_images: fig2
case_images: Given the suspicion for pulmonary embolism, he was presumptively started on low molecular weight heparin and computed tomography pulmonary angiogram was ordered (Figure 2).
case_images: Echocardiogram showing mild concentric left ventricular hypertrophy and a serpentine mass in the left atrium, consistent with thrombus.
case_images: CRIC2017-6752709.003.jpg
case_images: PMC5299177_01_CRIC2017-6752709.003.jpg
case_images: fig3
case_images: Echocardiogram (Figures 3 and 4 and Video 1 in Supplementary Material available online at https://doi.org/10.1155/2017/6752709) that morning remarkably displayed whirling echogenic mass in the atria and McConnell's sign.
case_images: Echocardiogram showing large thrombus in the right atrium.
case_images: CRIC2017-6752709.004.jpg
case_images: PMC5299177_01_CRIC2017-6752709.004.jpg
case_images: fig4
case_images: Echocardiogram (Figures 3 and 4 and Video 1 in Supplementary Material available online at https://doi.org/10.1155/2017/6752709) that morning remarkably displayed whirling echogenic mass in the atria and McConnell's sign.
case_images: Clot retrieved at embolectomy.
case_images: CRIC2017-6752709.005.jpg
case_images: PMC5299177_01_CRIC2017-6752709.005.jpg
case_images: fig5
case_images: The patient had right atriotomy and pulmonary endarterectomy with extraction of a large amount of thrombotic material that obstructed the pulmonary arteries (Figures 5 and 6).
case_images: Clot retrieved at embolectomy.
case_images: CRIC2017-6752709.006.jpg
case_images: PMC5299177_01_CRIC2017-6752709.006.jpg
case_images: fig6
case_images: The patient had right atriotomy and pulmonary endarterectomy with extraction of a large amount of thrombotic material that obstructed the pulmonary arteries (Figures 5 and 6).