Impending Paradoxical Embolism

Abstract

A 46-year-old woman was admitted with sudden onset of chest pain and severe dyspnea. Her past medical history was unremarkable despite a long-distance journey 1 week before. On examination, the patient was in obstructive shock with a peripheral oxygen saturation of 78%. The electrocardiogram showed right bundle branch block, a S1-Q3 pattern, and anterolateral ST segment depression. Blood test sampling provided elevated levels of high-sensitive troponin and D-dimer. Computed tomography of the chest confirmed massive pulmonary embolism (Figure 1A, arrows).