We have made huge progress with regards to awareness of HIV, but we must normalise testing in both primary and secondary care to decrease late and unknown HIV diagnoses. ■ latter contexts as well, CTPA can be deferred and pre-emptive thrombolysis initiated instead. 8,9 Alternatively, emergency pulmonary embolectomy might be deployed, as was the case in a haemodynamically compromised PE patient in whom transoesophageal echocardiography showed McConnell's sign as well as impending paradoxical embolism characterised by a thrombus straddling a patent foramen ovale. 10 ■