Post-operative. Bilateral lower limb oedema. Tachycardia.
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Extensive pulmonary emboli in multiple lobar and segmental arteries.
The interventricular septum is straightened in keeping with right heart strain.
Pulmonary emboli don't come any bigger or central than this. In addition, the bilateral clot burden is extensive.
Such a large clot burden as in this case usually results in right heart strain.