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She was sent to a regional hospital, where she received blood tests showing a high D-dimer level. However, chest CT showed no obvious thrombus over the pulmonary artery trunk. She was then transferred to the emergency care unit, where a low Lapatinib nmr O2 saturation under non-rebreathing mask was noted. Physical examination then revealed jugular vein engorgement and orthopnoea. Her D-dimer was 1294?ng/ml, and her cardiac enzyme level was normal. ECG showed right ventricular hypertrophy with qR pattern over V1 (figure 1B) and right axis deviation. Transthoracic echocardiography showed a high peak systolic pressure gradient of 140?mm?Hg across the tricuspid valve and moderate right ventricular systolic dysfunction. She was then admitted to the cardiac intensive care unit under a strong suspicion of pulmonary embolism. Figure?1 (A) Chest x-ray revealed a prominent enlarged pulmonary trunk and cardiomegaly with right ventricular hypertrophy. (B) ECG revealed right ventricular hypertrophy (qR pattern over V1) and right axis deviation. Case presentation A 25-year-old woman presented at an emergency care unit on her postpartum day 7 with severe dyspnoea, orthopnoea and chest pain. Chest x-ray (CXR; figure 1A) revealed a prominent enlargement of the pulmonary trunk and cardiomegaly with right ventricular hypertrophy. Her D-dimer was 1294?ng/ml and her cardiac enzyme levels were normal. The risk of deep Liothyronine Sodium vein thrombosis is increased during pregnancy, and further accrual and formation of new clots may increase the risk of pulmonary embolism. The patient denied any history of systemic disease except for a previous diagnosis with an unspecified congenital heart disease. The patient was afebrile, her blood pressure was 130/70?mm?Hg, regular pulse 87 bpm and respiratory rate 20?breaths/min with O2 saturation of 94% under nasal cannula 2?l/min. Jugular venous pressure had increased due to engorgement. Mild pitting oedema of the lower extremities was noted. Heart sounds were normal with no obvious murmurs and lungs were clear on auscultation. Crenolanib Abdominal examination was unremarkable. Investigations Blood tests by latex immunoassay revealed an abnormally high D-dimer of 1294?ng/ml (a normal D-dimer of
