Saddle pulmonary embolus with right heart strain
This is an interesting case of a previously well female patient who presented with progressive dyspnea of one week duration as her only symptom. By the time she presented to hospital she was in obstructive shock with evidence of acute right heart strain on CTPA and bedside echocardiogram. She received thrombolysis and then a heparin infusion and was stabilized.
The CTPA revealed bilateral axillary and mediastinal lymphadenopathy. Further workup with CT abdomen-pelvis revealed bulky para-aortic nodes and a conglomerate mass in the left pelvis which was causing extrinsic compression of the common iliac vein with associated intraluminal thrombus.
Lymph node biopsy diagnosed the patient with Lymphoma. This patient did not demonstrate any of the classic "B symptoms" of weight loss, night sweats or fever.
She went on to receive treatment for her newly diagnosed lymphoma and did not have any significant sequelae from her extensive pulmonary emboli.