A 60-year-old woman with breast cancer with brain and bone metastases presented to the emergency department with complaints of cough, progressive dyspnea, and hemoptysis. Initial vitals signs revealed a heart rate of 80 beats/min, respiratory rate of 26 breaths/min, blood pressure of 120/80 mm Hg, and room air pulse oxygenation of 88%. The patient also noted pain and swelling in her right lower extremity. When measured, the right lower extremity had a 4 cm greater diameter compared to the left. Because of the leg swelling, dyspnea, tachypnea, and an electrocardiogram (ECG) showing right heart strain, a transthoracic echocardiogram was performed at the bedside to evaluate for possible pulmonary embolism (Figure 1, Figure 2, Video 1).
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Published online: January 17, 2015
Accepted: November 16, 2014
Received in revised form: October 10, 2014
Received: June 5, 2014
Streaming video: One brief real-time video clip that accompanies this article is available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clip 1.
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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