Unexpected bilateral massive pulmonary embolism

摘要: A 59-year-old woman with a past history of rheumatoid arthritis arrived in our Emergency Department via ambulance. Her husband stated she had suddenly "appeared very strange" whilst preparing to go out for the afternoon, but could not identify specific symptoms. Physical examination showed her have sinus tachycardia and tachypnea, little else note. oxygen saturations however rapidly dropped when was taken off high-flow oxygen. d-dimer assay markedly elevated, urgent computed tomographic pulmonary angiography (CTPA) performed (Figures 1 2). This large emboli (black arrows) both left (Figure 1) right 2) arteries (white arrows), saddle embolus noted on right. Following CTPA, developed signs symptoms obstructive shock, requiring thrombolysis using tenectaplase admission intensive care unit. hospital stay complicated by lower respiratory tract infection discharged seventeen days after admission.