Impending Paradoxical Embolus

A 60-year-old woman with breast cancer with brain and bone metastases presented to the emergency department with complaints of cough, progressive dyspnea, and hemoptysis. Initial vitals signs revealed a heart rate of 80 beats/min, respiratory rate of 26 breaths/min, blood pressure of 120/80 mm Hg, and room air pulse oxygenation of 88%. The patient also noted pain and swelling in her right lower extremity. When measured, the right lower extremity had a 4 cm greater diameter compared to the left. Because of the leg swelling, dyspnea, tachypnea, and an electrocardiogram (ECG) showing right heart strain, a transthoracic echocardiogram was performed at the bedside to evaluate for possible pulmonary embolism (Figures 1 and 2, Video 1).
Source: The Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Visual Diagnosis in Emergency Medicine Source Type: research