about 80 y old patient with acute dyspnoea, hypertension and tachycardia; immobile for years. underlaying diseases: arterial hypertension, diabetes mellitus 2, \"high grade\" adiposity. NO known pulmonary disease (no clinical signs of bronchospasm).
In TTE (sorry for that bad quality) I could see a distinct pressure overload of RV with systolic shift of septum into LV. A classical McConnel-sign wasn´t seen. But in lower legs no thrombosis (maximum adipositas!). In my opinion that echocardipographic picture with the acute clinical afflictions is compatible with a pulmonary embolism. no ct of lung (kreatinine 3,0 mg/dl); I started UFH (aPTT 60-80 sec.). no catecholamines needed.