The acquired nonprecordial peripheral pulmonary murmur of pulmonary embolism

Two patients had noninvasive and invasive findings consistent with massive pulmonary emboli. Both patients had an acquired nonprecordial peripheral pulmonary murmur on physical examination. One patient also demonstrated a wide, fixed-split second heart sound in addition to the acquired murmur. Both of these physical findings have rarely been reported; however, when present, both the acquired nonprecordial murmur and the widely split second heart sound seem to be associated with extensive and massive pulmonary embolism and, when occurring together, are almost pathognomonic for pulmonary embolism.