This patient had been an in-patient for over a fortnight and attended for review after a weekend at home. She described acute dyspnea and was borderline hypotensive with a normal heart rate.
On the basis of her symptoms and the scan, she was re-admitted and treated with low molecular weight heparin and warfarinised. Her d-dimer was in the thousands and re-examination of the ECG showed the S1Q3T3 phenomenon associated with pulmonary emboli.