A 62 year old man presented with a two week history of dyspnoea on minimal exertion. His medical history was significant for stage IV pancreatic adenocarcinoma and non-Hodgkin's lymphoma. An admitting chest roentgenogram revealed a large left pleural effusion and evidence of bilateral hilar adenopathy. Following a left sided therapeutic thoracocentesis, there was no improvement in his symptoms. Spiral computed tomography of the thorax showed a saddle pulmonary embolus astride the main pulmonary trunk. Also noted incidentally in the figure is bilateral hilar adenopathy and pleural effusions.

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