A 48-year-old woman with panic attacks

Contrast-enhanced CT scan showed extensive bilateral pulmonary emboli (figure), with right ventricular dilatation and interventricular septal bowing, confirming the diagnosis of pulmonary embolism.1 Right ventricular dysfunction was shown on transthoracic echocardiography, with paradoxical movement of the ventricular septum. Acute thrombolysis was not considered because of her recent trauma and surgery, and stable vital signs.2 Anticoagulation was continued with the oral Xa inhibitor rivaroxaban.3 Compression ultrasonography of the right leg showed a deep vein thrombus with occlusion of the fibular, posterior tibial, and popliteal veins.