Ultrasound Case 012

Presentation

54 year old male presenting with collapse while moving couch. The patient is on antibiotics for recent pneumonia diagnosis. Altered mental status in the emergency department.

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Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Parasternal long axis of the heart with a large right heart and septum bowing into the left ventricle.

Image 2: Parasternal short axis of the heart, again showing a large right heart and a “D” shaped septum consistent with right heart strain.

Image 3: Longitudinal view of the IVC shows a plethoric IVC with spontaneous echo contrast.

Image 4: Femoral veins were compressed proximally and collapsed, showing no proximal femoral venous DVT.

Image 5: After the patient arrested, tPA 50 mg IV bolus was given, ROSC was achieved and the right heart strain is showing improvement.


CLINICAL CORRELATION

Massive pulmonary embolism and cardiac arrest.


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Michael Bogseth, MD. Ultrasound Fellow in Emergency Medicine. American Board of Emergency Medicine Diplomate | @mbogs001 | LinkedIn |

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