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case_images: Initial chest X-ray.
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case_images: A chest X-ray (Figure 1) showed accentuation of the reticular pulmonary pattern, predominantly on the right base, and increased cardiothoracic index (CTI).
case_images: Electrocardiogram.
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case_images: T waves (Figure 2). The laboratory data revealed normocytic anaemia (10.8 g/dL, reference value 11.5-16 g/dL; mean corpuscular volume 87.3 fL, reference value 80-100fL) and a slight elevation of inflammatory parameters (C-reactive protein 57.6 mg/L, normal value <= 5 mg/L).
case_images: Nodular formations on thoracic computed tomography (arrows).
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case_images: A thoracic computed tomography described micronodular opacities on the right pulmonary base and two nodular formations, the larger measuring 22 mm (Figure 3).
case_images: Pericardial effusion (thoracic computed tomography).
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case_images: A large circumferential PE and thickened leaflets were also noted (Figure 4).
case_images: Pericardial effusion (transthoracic echocardiogram).
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case_images: A transthoracic echocardiogram (TTE) indicated large circumferential PE (Figure 5), with a maximum of 37 mm adjacent to the left heart cavities, showing a 'swinging heart' and echocardiographic signs of haemodynamic compromise (significant respiratory variation in transvalvular flow velocities and collapse of the right cavities).