Emergency department bedside echocardiography diagnosis of massive pulmonary embolism with direct visualization of throm
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CASE REPORT
Emergency department bedside echocardiography diagnosis of massive pulmonary embolism with direct visualization of thrombus in the pulmonary artery David C. Riley • Aaron Hultgren • David Merino Samuel Gerson
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Received: 17 May 2011 / Accepted: 22 August 2011 / Published online: 16 September 2011 Ó Springer-Verlag 2011
Abstract A 62-year-old woman presented to the emergency department (ED) with a chief complaint of 3 weeks of progressively worsening shortness of breath. Her physical examination was normal, except for tachypnea. Her lungs were clear, and no murmurs, gallops or rubs were heard on the cardiac examination. ED bedside echocardiography with color, continuous wave and tissue Doppler ultrasound imaging and lower extremity ultrasonography performed by an ED attending physician revealed a massive pulmonary embolism with right ventricle pressure overload, tricuspid and pulmonic regurgitation, right atrial thrombus and a right popliteal thrombus. The right ventricular outflow tract view allowed for the direct visualization of thrombus in the pulmonary artery. Bedside echocardiography with color, continuous wave and tissue Doppler ultrasound imaging and lower extremity compression ultrasonography can assist the emergency physician and the critical care physician in the diagnosis of massive pulmonary embolism and deep venous thrombosis. Direct visualization of embolic thrombus in the pulmonary artery can help the ED physician accelerate both medical intensive care consultation and therapy and surgical consultation for possible thromboembolectomy and inferior vena cava filter placement.
Electronic supplementary material The online version of this article (doi:10.1007/s13089-011-0081-4) contains supplementary material, which is available to authorized users. D. C. Riley (&) A. Hultgren D. Merino S. Gerson Emergency Medicine Department, Columbia University Medical Center, New York, NY, USA e-mail: [email protected]
Keywords Emergency department Bedside echocardiography Massive pulmonary embolism Direct visualization of thrombus in pulmonary artery Pulmonary hypertension Tricuspid regurgitation Pulmonic regurgitation Right ventricle tissue Doppler Right ventricle pressure overload Hepatic vein pulse Doppler systolic reversal
Case report A 62-year-old woman with a past medical history of asthma and chronic obstructive pulmonary disease, presented to the emergency department (ED) with a chief complaint of 3 weeks of progressively worsening shortness of breath distinctly different from her usual asthma exacerbation symptoms. She had no history of cancer, pulmonary embolism or deep venous thrombosis, and she denied any recent plane flights or upper or lower extremity trauma. She reported no abdominal, back or chest pain. She had no history of coughing, fever, chills or chemical exposures. She denied smoking. Her ED vital signs were temperature 98.0°F, blood pressure 123/89 mmHg, respiratory rate 18 bpm, room air oxygen saturation 96%, and a heart rate of 109 bpm. Her ECG was nor
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