Abstract
An 81-year-old woman with myeloma and a recent fractured femoral neck presented after a collapse. On arrival, she was tachycardic, hypotensive, and hypoxic. ECG showed incomplete right bundle branch block, prominent S waves in lead I, Q waves and T-wave inversion in lead III (FigureA, black arrows). Echocardiography, performed by a cardiologist in the emergency department (ED), revealed classic features of massive pulmonary thromboembolism, with right ventricle enlargement and regional impairment of the right ventricle free wall (McConnell’s sign) ( FigureB; Video E1, available online at http://www.annemergmed.com), 1 compression of the left ventricle, and a large serpentine thrombus in the right atrium, which extends into the right ventricle ( FigureB, white arrow; Video E1, available online at http://www.annemergmed.com).
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