A 70 years old man came with complaint of breathing difficulty with cough for past 6 hours. On examination, pulse rate was 120/min and BP was 80/40 mm of hg. Swelling was also seen in left lower limb. Urgent venous Doppler of left lower limb was performed and revealed left CFV thrombosis. D-dimer assay came out to be positive. CT pulmonary angiogram was performed. Diagnosis is-

Coronal CTPA shows extensive burden of large pulmonary emboli manifested by occlusive and mural filling defects whose edges form acute angles with the vessel walls (white arrows). The clinical presentation of acute PE is variable. Up to two-thirds of patients may be asymptomatic, or sudden death may be the first presentation. Common clinical presentations of acute PE include chest pain, tachycardia, hypotension, dyspnea, cough, and hemoptysis. Massive PE presents with hypotension, shock, or cardiac arrest. electrocardiography (EKG) changes of S1Q3 pattern, S1Q3T3 pattern, notched S wave in lead V1, inveed T waves, and right bundle branch block may be seen in patients with right hea strain (7). Signs and symptoms of proximal deep vein thrombosis (DVT) include lower extremity swelling, edema, erythema, and pain. Direct findings of acute PE in CT include a central filling defect within a vessel surrounded by contrast material yielding a "polo mint" appearance when ohogonal to the long axis of the vessel or a "railway sign" when observed parallel to the vessel long axis.