A hill hidden by the clouds

"A 33-year-old woman, with a past medical history of polysubstance abuse and recently treated infective endocarditis, is admitted with septic shock due to pneumonia. The chest x-ray reveals right middle and lower lobe infiltrates plus a right pleural effusion (Figure 1). Because of persistent tachycardia and hypoxia, computed tomography (CT) of the chest with contrast was performed. It revealed a large pulmonary embolus (PE) involving the right main pulmonary artery (PA) and an absence of distal arterial filling (Figures 2, 3). Transverse images demonstrated a wedge-shaped density consistent with a pulmonary infarct (Figure 4)."Most Munira, Gurchetan Randhawa, Aviva Dworkin, Wendy Moh, Kenneth Ong (Department of Medicine, Lincoln Medical Center)Includes bibliographical reference