A male in his 60s presented complaining of dysnpea and chest pain.  He was tachypneic and ill appearing.

I was texted this ECG.  The physician worried about PE mostly, but also MI:

My response was: “incomplete RBBB.  No evidence of acute MI.  Certainly could be PE.  What does the cardiac echo show?”

The bedside echocardiogram showed a serpiginous echogenic structure in the right atrium that was also flowing in and out of the right ventricle.  The RV was enlarged.

I am sorry that I had to take this video down because my colleague wants to submit it to an academic journal.  I have left the still frame in.

Still frame of the video: Blue circle show thrombus snaking throughout right atrium and right ventricle.

The patient was given IV tPA and rapidly improved.  A subsequent ultrasound showed no more thrombus.