A patient presents with severe chest pain and shortness of breath. What’s the diagnosis?
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Saddle pulmonary embolic disease is present. A filling defect extends from the aortic lumen into the right coronary artery ostium, which is occluded. A defect in the interatrial septum is evidenced by dense contrast in the right side of the left atrium, isodense to contrast in the right atrium and an adjacent septal deficiency, likely representing a patent foramen ovale. The constellation of findings suggest extensive pulmonary embolic disease, with paradoxical embolism to the right coronary artery likely resulting in right coronary arterial territory ischaemia.
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Clinical information: 36 year old male. Shortness of breath and chest pain.
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