The authors report the case of a 44-year-old man with clinical and echocardiographic features of massive pulmonary embolism. However, a pulmonary angiogram did not reveal any large embolus. Desquamative interstitial pneumonia and bronchopneumonia were found at autopsy.

Severe right ventricular strain in a patient with acute onset of pleuritic chest pain, hemodynamic collapse, and hypoxemia is strongly suggestive of an acute life-threatening pulmonary embolism.11 Right ventricular strain and elevated pulmonary artery pressures, however, are not restricted to acute pulmonary embolism. These features can also be present in other conditions, including severe interstitial lung disease and an extensive right ventricular infarct.22 

We present a patient with clinical and echocardiographic features of massive pulmonary embolism who was taking warfarin for recently diagnosed pulmonary embolism. Thrombolysis was considered as a possible treatment but was not undertaken. After respiratory...

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