PMC7190873_01
Admission CXR: bilateral lung infiltrates right greater than left.
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Arterial Blood Gas (ABG) on room air showed pH 7.37, PaCO2 29.9 mmHg, PaO2 45.5 mmHg indicating acute hypoxic respiratory failure. Admission chest X-ray (CXR) showed bilateral infiltrates, more on the right (seen in the right middle/lower lobes) (Fig. 1).
EKG shows SIQIIITIII pattern.
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There was a concern for PE given that the patient had worsening hypoxia, had sinus tachycardia as well as new onset paroxysmal atrial fibrillation and EKG had revealed a new S1QIIITIII pattern (Fig. 2).
CTA chest reveals a saddle pulmonary embolism, as indicated by the arrows.
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Tomography Angiography (CTA) revealed a saddle PE (Fig. 3). The patient became lethargic while on BiPAP and hypoxia was not improving, therefore she was upgraded to the Intensive Care Unit and intubated for respiratory support.