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Assembly

Point of Care Changing the Place of Care

Authors
Adil Alexander Yunis, MD1, Jeffrey A Fowler, DO1, Phillip Edward Lamberty, MD2.
1Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA,
2Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA


Case

A 59-year-old male presented to the emergency room with four days of progressive dyspnea on exertion after a long drive. On the day of admission, he experienced sudden worsening dyspnea at rest. His past medical history was significant for hypertension, chronic obstructive pulmonary disease and tobacco use.

Exam: HR 110, BP 106/61, RR 24, SpO2 100% on 6L NC. Lungs: Clear to auscultation

Labs: WBC 14.9, Hg 11.7, PLT 221, lactate 1.1, Troponin I 0.06, BNP 856.

Imaging: CTPA

CTPA
Cine loop of CT scan

Question

What is the diagnosis?

A. Pulmonary embolism
B. Pulmonary embolism with clot in transit
C. Pulmonary embolism with clot in transit and impending paradoxical embolism
D. Tricuspid Valve endocarditis

Answer