Large pulmonary embolism with right heart strain
Shortness of breath and sudden rise of troponin.
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Extensive pulmonary emboli within the main pulmonary arteries bilaterally extending into the upper lobe, middle lobe and lower lobe divisions. Much of the thrombus is nonocclusive, with occlusive thrombus involving the left upper lobe lingula and right middle lobe medial segment branches. There is associated dilatation of the right heart with bulging of the interventricular septum consistent with right heart strain. A solitary nonspecific 3 mm nodule is identified in the right lung apex otherwise the lungs are clear.