case_images: PMC9310331_01
case_images: (a) CXR on admission. (b) Follow-up CXR on Day 19.
case_images: 10.1177_2050313X221113934-fig1.jpg
case_images: PMC9310331_01_10.1177_2050313X221113934-fig1.jpg
case_images: fig1-2050313X221113934
case_images: On admission, the chest X-ray (CXR) showed diffuse patchy bilateral pulmonary opacities (Figure 1(a)). Day 10, a repeat CXR showed extensive bilateral airspace disease, densest in the left lower lung. During the further hospital course, the CXRs showed stable extensive bilateral mixed airspace disease (Figure 1(b)).
case_images: CT pulmonary angiogram showing a right lower lobe pulmonary arterial thrombus. (Arrow marks the thrombus).
case_images: 10.1177_2050313X221113934-fig2.jpg
case_images: PMC9310331_01_10.1177_2050313X221113934-fig2.jpg
case_images: fig2-2050313X221113934
case_images: On Day 11, computed tomography pulmonary angiography (CTPA) showed right lower lobe PE on top of bilateral pneumonia (Figure 2).
case_images: (a) Transthoracic echocardiogram showing a dilated right ventricle with a mobile echodensity suggestive of thrombus (Day 11). (b) Similar echocardiographic view after two tPA treatments (Day 14). (c) Echocardiographic showing recurrence of the RV thrombus (Day 21). In this occasion, a globular RV thrombus in transit "caught" in the tricuspid chordae was observed.
case_images: 10.1177_2050313X221113934-fig3.jpg
case_images: PMC9310331_01_10.1177_2050313X221113934-fig3.jpg
case_images: fig3-2050313X221113934
case_images: The echocardiogram showed a dilated right ventricle with a mobile echo density of 11x12 mm, suggestive of RV thrombus (Figure 3(a)). On Day 14, a repeat echocardiogram revealed the resolution of the RV thrombus (Figure 3(b)). However, on Day 20, the patient deteriorated clinically, and a repeat echocardiogram detected a second RV thrombus, with a size larger than the previous one (Figure 3(c)). A subsequent echocardiogram confirmed the resolution of the thrombus (Figure 3(b)). The echocardiogram showed a mass suggestive of RV thrombus that was not seen on the echocardiogram done on Day 14 (Figure 3(b) and (c)).