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A 75-year-old man was urgently referred for evaluation of a syncopal episode accompanied by head trauma and lacerations. Chest CT angiography showed bilateral pulmonary emboli (PE) along with right atrial and ventricular filling defects (figure 1A–C). Lower extremity ultrasound showed bilateral deep venous thromboses. An echocardiogram demonstrated severe right ventricular dysfunction with extensive ‘popcorn thromboemboli’ in the right atrium prolapsing into the right ventricle during atrial systole (figure 1D-1, E-1). Thrombolytic therapy was contraindicated due to recent head trauma. Despite his concerning presentation, the patient initially declined surgical intervention.
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