PMC9310331_01
(a) CXR on admission. (b) Follow-up CXR on Day 19.
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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)).
CT pulmonary angiogram showing a right lower lobe pulmonary arterial thrombus. (Arrow marks the thrombus).
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On Day 11, computed tomography pulmonary angiography (CTPA) showed right lower lobe PE on top of bilateral pneumonia (Figure 2).
(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.
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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)).