title: Pulmonary embolism with unexpected echocardiogram findings.
abstract: A 56-year-old woman was evaluated for dyspnea in the emergency department. She had no risk factors for venous thromboembolism except hormone replacement therapy; however, pulmonary embolism was suspected and subsequently confirmed via computed tomographic angiogram. An echocardiogram was conducted to further assess right ventricular function, revealing marked right ventricular enlargement and a mobile mass in the left atrium (initially suspected to be an atrial myxoma). After subsequent embolization to the left axillary artery, thrombolysis was administered, and embolectomy confirmed this to be thrombus. A repeat echocardiogram showed resolution. This case highlights that although echocardiography can be helpful in risk stratification when assessing patients with pulmonary embolism, unexpected findings may be encountered. When clinicians identify multiple clinical findings, Occam's razor suggests that these multiple findings are most likely related.
authors.affiliation: University of Utah School of Medicine, Salt Lake City, UT 84132, USA. kencee.graves@hsc.utah.edu
authors.forename: Kencee K
authors.initials: KK
authors.lastname: Graves
authors.forename: Larry S
authors.initials: LS
authors.lastname: Green
authors.forename: Robert C
authors.initials: RC
authors.lastname: Pendleton
mesh_terms: D000208:Acute Disease; D001366:Axillary Artery; D004417:Dyspnea / Q000209:etiology; D017548:Echocardiography, Transesophageal; D017128:Embolectomy; D004621:Embolization, Therapeutic; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000150:complications / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D018570:Risk Assessment; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy