Rationale: Right heart thrombi (RiHT) is characterized by the presence of thrombus within the right atrium or right ventricle (RV). Current literature suggests pulmonary embolism (PE) with RiHT carries a high mortality. Guidelines lack recommendations in managing RiHT. We created a pooled analysis on RiHT and report on our institutional experience in managing RiHT. We aimed to evaluate whether patient characteristics and differing treatment modalities predict mortality. Methods: We created a pooled analysis of case reports and series of patients with RiHT and PE between January 1956 and 2017. We also reviewed a series of consecutive patients with RiHT identified from our institutional PE registry. Age, shock, RV dysfunction, clot mobility, treatment modality, and hospital outcome had to be reported. Results: We identified 316 patients in our pooled analysis. Patients received the following therapies: no treatment 15 (5%), systemic anticoagulation 73 (23%), systemic thrombolysis 108 (34%), surgical embolectomy 101 (32%), catheter-directed therapy 11 (3%), and systemic thrombolysis with surgery 8 (3%). In-hospital mortality was 18.7%. Univariate analysis showed age and shock reduced odds of survival. Multivariate analysis showed shock reduced odds of survival (odds ratios [OR] 0.36, 95% confidence interval [CI]: 0.19-0.72, P ≤ .01) while age, RV dysfunction, and clot-mobility did not affect mortality. In a reduced multivariate analysis adjusting for shock, treatment modality, and clot location alone, systemic thrombolysis increased odds of survival when compared to systemic anticoagulation (OR 2.72, 95% CI: 1.11-6.64, P = .02). Our institutional series identified 18 patients, where in-hospital mortality was 22.2%, 18 (100%) had RV dysfunction, and 5 (28%) had shock. Patients received the following therapies: systemic anticoagulation 8 (44.4%), systemic thrombolysis 4 (22.2%), surgical embolectomy 4 (22.2%), and catheter-directed thrombolysis 2 (11.1%). Conclusion: Presence of shock in RiHT is an independent predictor of mortality. Systemic thrombolysis may offer increased odds of survival when compared to systemic anticoagulation. Our findings should be interpreted with caution as they derive from retrospective reports and subject to publication bias.

significantly altered by right lung hyperinflation and resultant compression atelectasis and impaired diaphragm excursion. He was unable to trigger the ventilator resulting in dysynchrony, air hunger, worsened hyperinflation and atelectasis and carbon dioxide retention. In order to achieve synchrony, he was transitioned to NAVA ventilation. Once on NAVA, the patient was able to maintain minute ventilation, was weaned from sedation and had improvement in overdistension, atelectasis and gas exchange. While there is limited data describing its use in older infants, in the setting of prolonged ventilation, and/or inability to flow trigger the ventilator, the use of NAVA should be considered early to improve patient ventilator synchrony and minimize ventilator associated lung injury.Case Report: Serratia marcescens, a gram-negative bacilli, is responsible for approximately 2% of nosocomial lower respiratory tract and urinary tract infections. The risk of developing Serratia infections are increased in patients who are admitted to ICUs, immunocompromised, treated with long-term broadspectrum antibiotics, and have had instrumentation, such as indwelling catheters and tracheostomy tubes. The most striking feature of this member of the Enterobacteriaceae family, is its ability to produce prodigiosin, a red pigment that is responsible for the documented manifestation of pseudohemoptysis in patients who have Serratia pneumonia. We report a case of an 88-year-old man with chronic tracheostomy secondary to a history of intracranial hemorrhage, admitted to our institution for hemoptysis of one day's duration without signs of systemic infection. Upon admission, blood was noted in both the oropharynx and tracheostomy tube. Vitals signs were normal without signs of SIRS or infection and laboratory data showed mild leukocytosis and borderline urinalysis for which he was started on antibiotics. Lung examination and chest radiograph were unrevealing for pneumonia. On day 2, a bronchoscopy was performed that did not reveal a source of bleeding. On day 3, direct laryngoscopy performed by ENT also did not reveal a bleeding source in upper respiratory tract. Bronchoalveolar lavage washings which had been sent for culture ultimately grew Serratia marcescens and Providencia. While there have been published cases of pseudohemoptysis associated with Serratia pneumonia, there has been no report, to our knowledge, of Serratia colonization causing pseudohemoptysis. Clinical awareness of this finding may help deter unnecessary antibiotics and procedures in these patients and reduce length of hospitalization.Case Report: Kaposi's sarcoma is a low-grade mesenchymal tumor involving blood and lymphatic vessels. It is the most common tumor among patients with HIV infection, occurring predominantly in homosexual or bisexual men. A 55-year-old male with no known medical history, presented with weakness and malaise, worsening over the course of 6 mo. He had no toxic habits, and he was a homosexual. He was tachycardic (155 bpm), tachypneic (25 bpm) and ...

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