Postgraduate Education Corner ULTRASOUND CORNER CHEST

A 44-year-old man presented to our ED with pro-gressive shortness of breath and left-sided pleuritic chest pain. His history was remarkable for alcohol and tobacco abuse. On examination, his vital signs were stable except for sinus tachycardia (119 beats/min). Laboratory values for cardiac markers were within normal limits, and chest roentgenogram was notable for a wedge-shaped infi ltrate ( Fig 1). Acute pulmo-nary embolism (PE) was suspected, and CT pulmo-nary angiography (CTPA) was performed. The CTPA showed multiple PEs in segmental branches and wedge-shaped infarcts in the bilateral lower lobes ( Fig 2). In addition, a mass was noted near the periph-ery of the right hepatic lobe, suspicious for a malig-nancy ( Fig 3). The patient was treated for acute PE with heparin and transitioned to warfarin. In addi-tion, investigations were undertaken to further char-acterize the liver mass. Biopsy of the liver mass was deferred because of the immediate need for antico-agulation and was scheduled to be obtained as an out-patient. The patient was discharged with improvement in his symptoms. Three weeks later, the patient returned to the ED because of sudden onset of chest pain and shortness of breath. The patient had been compliant with his anti-coagulation, and records indicated international nor