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Figure 6. Acute dilatation of the RV with leftward septal bowing in a 68-year-old woman who presented with severe dyspnea and severe hypotension. CT pulmonary angiography showed massive PE, and the PA clot load score calculated according to Qanadli et al (47) was 57%. She underwent a Trendelenburg intervention but died during the first 24 hours after admission. Axial CT pulmonary angiogram obtained at the level of the heart shows signs of cor pulmonale. Note the severe dilatation of the RV and the compression of the LV: The short-axis diameters of the RV and LV were 59.4 mm and 24 mm, respectively, and the RV/LV diameter ratio was 2.5. Also note the leftward bowing of the inter-ventricular septum (arrowhead).
