Pulmonary embolism is one of the most common causes of in-hospital mortality,'-3 although in a high percentage of cases it occurs as a complication of another underlying d i ~e a s e . ~ -6 Unfortunately, it remains undiagnosed in the majority of cases because either the symptoms are not characteristic and misleading or there are no clinical symptoms at all in cases of minor e m b ~l i . ' ' ~, ~, ~ Not infrequently, however, the diagnosis is missed because it has not been considered. Nonetheless, early diagnosis is essential for initiation of appropriate treatment, which considerably improves the prognosis of the d i ~e a s e . ~, ~
In the case presented below, the diagnosis of an intracardiac thromboembolus and an acute cor pulmonale from recurrent pulmonary embolism was made with two-dimensional echocardiography. The decision to send the patient to surgery for pulmonary and intracardiac embolectomy was based on echocardiographic findings.
CASE REPORT
A 76-year-old woman was admitted to the hospital because of deep vein thrombosis of her left leg. The first symptoms had occurred about 3 weeks earlier. Two days before admission she had developed left-sided chest pain that was intensified by deep respiration and motion. She had first been seen in another hospital, where a chest x-ray had shown a small zone of increased density in the left lower lung. Otherwise, the lungs and the heart were radiologically normal, but the thoracic aorta was mildly dilated with discrete calcification of the aortic arch. In the From the 1. Medizinische Klinik, Klinikum rechts der Isar,