PMC5299177_01
Electrocardiogram showing sinus tachycardia and right ventricular strain pattern S1Q3T3 (deep S wave in lead I, Q wave in lead III, and inverted T wave in lead III).
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Laboratory results (Table 1) showed significantly elevated D-dimer and electrocardiogram showed sinus tachycardia with S1Q3T3 pattern (Figure 1). Echocardiogram (Figures 3 and 4 and Video 1 in Supplementary Material available online at https://doi.org/10.1155/2017/6752709) that morning remarkably displayed whirling echogenic mass in the atria and McConnell's sign.
CT pulmonary angiogram revealed a saddle embolus extending into the main, lobar, and segmental pulmonary arterial branches bilaterally with massive clot burden and near complete occlusion of the right main and branch pulmonary arteries.
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Given the suspicion for pulmonary embolism, he was presumptively started on low molecular weight heparin and computed tomography pulmonary angiogram was ordered (Figure 2).
Echocardiogram showing mild concentric left ventricular hypertrophy and a serpentine mass in the left atrium, consistent with thrombus.
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Echocardiogram (Figures 3 and 4 and Video 1 in Supplementary Material available online at https://doi.org/10.1155/2017/6752709) that morning remarkably displayed whirling echogenic mass in the atria and McConnell's sign.
Echocardiogram showing large thrombus in the right atrium.
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Echocardiogram (Figures 3 and 4 and Video 1 in Supplementary Material available online at https://doi.org/10.1155/2017/6752709) that morning remarkably displayed whirling echogenic mass in the atria and McConnell's sign.
Clot retrieved at embolectomy.
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The patient had right atriotomy and pulmonary endarterectomy with extraction of a large amount of thrombotic material that obstructed the pulmonary arteries (Figures 5 and 6).
Clot retrieved at embolectomy.
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The patient had right atriotomy and pulmonary endarterectomy with extraction of a large amount of thrombotic material that obstructed the pulmonary arteries (Figures 5 and 6).