54 year old male presenting with collapse while moving couch. The patient is on antibiotics for recent pneumonia diagnosis. Altered mental status in the emergency department.
Describe and interpret these scans
Image 1: Parasternal long axis of the heart with a large right heart and septum bowing into the left ventricle.
Image 2: Parasternal short axis of the heart, again showing a large right heart and a “D” shaped septum consistent with right heart strain.
Image 3: Longitudinal view of the IVC shows a plethoric IVC with spontaneous echo contrast.
Image 4: Femoral veins were compressed proximally and collapsed, showing no proximal femoral venous DVT.
Image 5: After the patient arrested, tPA 50 mg IV bolus was given, ROSC was achieved and the right heart strain is showing improvement.
Massive pulmonary embolism and cardiac arrest.