The large embolus draped over the pulmonary artery bifurcation is non-occlusive. However, the distal pulmonary artery branches were full of occlusive thrombus and right heart pressures were high.

The decision was made to thrombolyse based on radiological burden of clot, evidence of right heart strain and her clinical signs and symptoms.

She made a complete recovery following appropriate resuscitation and thrombolysis. Follow up confirmed a Factor V Leiden deficiency.