Mild improvement of the filling defect in the left lung showed a resolution of the non-obstructive filling defect previously seen in the left main pulmonary artery. The computed tomography (CT) scan for PE in Figure 1 showed redemonstrations of an extensive PE with right ventricular strain. The Doppler ultrasound (USG) showed right-sided deep vein thrombosis (DVT). The right ventricular systolic pressure (RVSP) was 50-60 mmHg. There was also a mild to moderate tricuspid regurgitation. It was attached to the upper side of the RA. His right atrium (RA) was dilated and there was a large irregular shape mobile mass in RA protruding into RV. The echocardiogram (ECHO) examination showed that the patient’s right ventricle (RV) was moderately dilated and depressed in function. His peripheral capillary oxygen saturation (SpO2) was 99% on 6 liters per minute (LPM) simple face mask, his abdomen was soft, and his urine output was normal. His breath sound was bronchial but tachypneic (respiratory rate (RR) 25 breaths per minute (BPM)). The initial assessment (Table 1) showed that the patient was conscious (Glasgow Coma Scale (GCS) 15/15) and recorded tachycardia (heart rate (HR) 112) with 109/80 mmHg blood pressure (BP). In addition, the patient was also complaining of severe chest pain mainly on the left side, with increasing respiration and chest movement. The patient complained about major pain from dyspnea that gradually increased and became worse. He reported that he had taken one dose of the coronavirus disease 2019 (COVID-19) vaccine (AstraZeneca) around two months back. He was brought to the Emergency Room (ER) and his medical history was analyzed. A 35-year-old man was admitted on September 6, 2021, due to massive PE and intracardiac thrombus.
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