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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.

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Younger patients without cardiopulmonary comorbidities are at highest risk of PI. Chest pain and pleural effusion significantly increased risk of PI while presence of radiographic emphysema reduced risk.

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One of the important advantages of the picture archiving and communication system (PACS} is the time saved in comparison with the conventional system. A group of 100 radiologic studies done in a conventional radiology department is compared with another group of the same number done in a completely filmless PACS department to assess the difference in the radiologist report turnaround time. There was a statistically significant (P < .00001) decrease in the median imaging-to-dictation time ( p ICTURE ARCHIVING and communication system (PACS) is a hardware and software package that acts asa digital image management system in the health institute. It enables the radiologists and clinicians to retrieve and view a radiologic image at computer workstations throughout the institute.l-4 In the conventional system, the film acts as the unique image document used for image capture, viewing, and storage. Eliminating films from the radiology department is one of the most important features of PACS. By doing so, PACS eliminates all the film-associated workload. This includes film processing, filing film folders, and retrieving previous studies from film stores. Time spent on these steps constitutes a considerable part of the total radiology tumaround time. 5 Further delays could be caused by losing films or having them taken by the clinicians before being reported. That is why PACS is expected to reduce the report turnaround time significantly even in the most efficient radiology department. 5-8The radiology department of the Adelaide & Meath Hospital, Incorporating the National Children's Hospital (AMNCH) is the first in Ireland to install and operate a complete PACS. The PACS was installed in the new hospital in Tallaght and started operating the day of hospital opening on June 21, 1998. An average of 300 studies are performed daily in this department.The current study was planned with the aim of evaluating the effects PACS implementation in our department might have on radiology turnaround time. MATERIALS AND METHODSA total of 200 radiologic examinations performed in the radiology department of the AMNCH hospital were analyzed. One hundred of these examinations were done in the pre-PACS department in May 1998; the rest were done in the PACS operated department in November 1998 4 months after moving to the new hospital. The distribution of the studies by imaging modality was comparable between the 2 groups and represented the actual department's study mix. Three radiologists reported on the same type of studies in both groups.Forms were distributed for every examination recording the dates and times from the patient's arrival into the department to the time the report was typed. The time intervals between imaging to dictating the report (imaging-to-dictation time, IDT), and then to typing ir (dictation-to-typing time, DTT) were computed. The IDT is the main outcome of this analysis. DTr is used as an internal control in this analysis because there was no significant changes involving typing dictated reports in the new depar...

This is the first study to evaluate pulmonary critical care fellows' and intensivists' use of goal-directed echocardiography in diagnosing right ventricular dysfunction in acute pulmonary embolism. Pulmonary Critical Care Medicine Fellows and intensivists made a timely and accurate assessment. Screening for right ventricular dysfunction using goal-directed echocardiography can and should be performed by pulmonary critical care physicians in patients with acute pulmonary embolism.

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