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A 23-year-old woman presented to the emergency department with severe right-sided chest pain, dyspnoea, pre-syncope and hypoxia. Ventilation–perfusion scintigraphy demonstrated complete absence of perfusion of the right lung, suggestive of massive unilateral pulmonary embolus (panel A). CT pulmonary angiography confirmed near-absent right lung blood-flow, but no emboli. Invasive pulmonary angiography revealed …