Description

A 61-year-old man with a history of hypertension and obesity presented with acute onset dyspnoea, light-headedness and right-sided pleuritic chest pain. The physical examination showed sinus tachycardia and a right-sided pleural rub. Oxygen saturation on initial presentation was 89% on room air by pulse oximetry. A 12-lead ECG showed a new S1Q3T3 pattern (figure 1A). Contrast-enhanced chest CT showed a large saddle pulmonary embolism (PE), with extensive involvement of several segmental and subsegmental arteries (figure 1B), a wedge-shaped opacity in the right middle lobe suggesting a pulmonary infarct and a small right pleural effusion (figure 1C,D). Bedside echocardiography did not indicate any right ventricular strain. The …