How bad can life be? A case of concurrent cardiac tamponade and pulmonary embolus

We present a rare case of a patient presenting with submassive pulmonary embolism (PE) further complicated by cardiac tamponade with the clinical dilemma on whether to perform thrombolysis or emergency pericardiocentesis to save her life. The aetiology of her pericardial effusion remains unclear but may possibly relate to post-PE pericarditis, a condition that resembles Dressler's syndrome. The pathophysiological processes of concurrent PE and cardiac tamponade combined to result in an unusual right ventricular shape on transthoracic echocardiography, and our findings raise the possibility of a fourth mechanism for the explanation of McConnell's sign - restricted free wall dilation via the moderator band.