Pseudo-high risk acute pulmonary embolism resulting from a large saddle aortic paradoxical embolus with subclavian artery occlusion

Abstract

A 75-years-old woman with acute dyspnea was diagnosed for suspected acute pulmonary embolism (APE). Initially, she was stable with blood pressure of 135/80mmHg, tachycardia of 105bpm and oxygen blood saturation of 84%. Computed tomography pulmonary angiography (CTPA) showed a bilateral central pulmonary embolism and an enlarged right ventricle (RV).After this examination, a sudden drop in systolic blood pressure to 80mmHg was reported.She was classified as a high-risk APE and referred immediately to a tertiary cardiology care unit.On admission to our department, the patient was in good general condition without peripheral hypoperfusion. Her left hand was colder without a palpable pulse, however without signs of acute ischemia. A difference of 60mmHg in systolic blood pressure between upper extremities