case_images: PMC4568365_01
case_images: 12-lead EKG showing right ventricular strain pattern.
case_images: CRIPU2015-481357.001.jpg
case_images: PMC4568365_01_CRIPU2015-481357.001.jpg
case_images: fig1
case_images: Laboratory findings revealed elevated lactic acid, troponin, d-dimer, and abnormal EKG (Table 1, Figure 1).
case_images: Computed Tomographic Pulmonary Angiogram (CTPA) showing massive saddle pulmonary embolus (bold arrow) with hypodense area at the root of pulmonary artery consistent with other emboli (white arrow).
case_images: CRIPU2015-481357.002.jpg
case_images: PMC4568365_01_CRIPU2015-481357.002.jpg
case_images: fig2
case_images: Urgent CT angiogram showed extensive bilateral pulmonary embolus (Figure 2), and bedside echocardiogram revealed right ventricular (RV) pressure overload with enlarged RV (>41 mm) and mobile echodensity attached to tricuspid valve that appeared to extend into right atrium and ventricle, RHTVE (Figure 3).
case_images: Transthoracic echocardiogram, apical 4-chamber view, showing RV pressure overload with enlarged RV diameter (>41 mm) and a long echodensity (embolus) attached to TV extending in both RA and RV (RHTVE); LA: left atrium; RV: right ventricle; RA: right atrium; LV: left ventricle; TV: tricuspid valve; emb: embolus; RHTVE: Right Heart Transvalvular Embolus.
case_images: CRIPU2015-481357.003.jpg
case_images: PMC4568365_01_CRIPU2015-481357.003.jpg
case_images: fig3
case_images: Urgent CT angiogram showed extensive bilateral pulmonary embolus (Figure 2), and bedside echocardiogram revealed right ventricular (RV) pressure overload with enlarged RV (>41 mm) and mobile echodensity attached to tricuspid valve that appeared to extend into right atrium and ventricle, RHTVE (Figure 3).
case_images: Postoperative demonstration of (a) a large (~25 cm) pulmonary embolus en bloc (bold arrow) retrieved from the right and left pulmonary arteries; (b) a long segment of embolus (doted arrow) traversing along tricuspid valve (TV). Both of them were removed in the same open embolectomy under cardiopulmonary bypass procedure.
case_images: CRIPU2015-481357.004.jpg
case_images: PMC4568365_01_CRIPU2015-481357.004.jpg
case_images: fig4
case_images: On follow-up with the tertiary center, a long segment of blood clot traversing the right atrium and ventricle (Figure 4(b)) and extensive bilateral pulmonary artery embolus (Figure 4(a)) were removed.