A 55 year old male presents to the emergency department with a 5 day history of increasing shortness of breath on exertion and recent leg “cramps”.  In the 24 hours prior to presentation he had noticed increasing back pain and hyperventilation, with one episode of hemoptysis.  The patient was tachycardic, transiently (30 minutes) hypotensive and had an oxygen saturation of 90% on non-rebreather mask with marked dyspnea.

A point of care echocardiogram was performed and demonstrated the following:

Parasternal Long Axis

 

Parasternal Short Axis

 

Inferior Vena Cava

 

What is your impression of the images?  Is there any significant abnormalities seen?  Click HERE  for the answers and discussion and to learn the outcome of the case.