A 52-year-old businessman with nephrotic syndrome after a non-stop flight from New York to New Delhi presents with sudden onset of breathlessness, haemoptysis, and chest pain. He is brought into Casualty in shock. His chest X-ray is normal. The ECG shows sinus tachycardia.

1. In this patient no pulmonary edema, MI absent and aoic dissection also absent. 2. Nephrotic syndrome patient will be in hypercoagulable state, long flight- DVT- pulmonary embolism- acute Cor pulmonale 3. Most common causes of Cor pulmonale- pulmonary embolism 4. CXR is normal because it is only a small clot and clot usually not visible on X-ray