Diagnosis of Near-fatal Pulmonary Embolus-in-transit with Focused Echocardiography

Fischer, Jonathan I.; Veld, Maite A. Huis in ‘t; Orland, Michael; Harvey, Patrick; Panebianco, Nova L.; Dean, Anthony J.

doi:10.1016/j.jemermed.2013.03.015

Cited by 14 publications

(12 citation statements)

References 24 publications

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“…Timely diagnosis of massive PE, using bedside echocardiography, has directed the treatments of subsequent thrombolysis or even surgical embolectomy in previous reported cases [4,5,8]. In our present case, besides echocardiographic findings, a history of syncope and the presence of unilateral lower extremity swelling reinforced the clinical suspicion of acute PE.…”

supporting

confidence: 60%

“…Diagnosis is often clinical, mainly based on the medical histories, symptoms, and signs before presentation [2]. Bedside echocardiography is readily available and has the potential to make a great clinical impact in patients with cardiac arrest, which can direct thrombolytic therapy or even emergency surgery [3][4][5]. We present a case of successful extracorporeal cardiopulmonary resuscitation (ECPR) for refractory pulseless electrical activity (PEA) after thrombolytic therapy in bedside echocardiography-diagnosed acute massive PE.…”

mentioning

confidence: 99%

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Extracorporeal cardiopulmonary resuscitation in bedside echocardiography–diagnosed massive pulmonary embolism

Jeong

Lee

Yoo

et al. 2015

The American Journal of Emergency Medicine

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supporting

confidence: 60%

mentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation in bedside echocardiography–diagnosed massive pulmonary embolism

Jeong

Lee

Yoo

et al. 2015

The American Journal of Emergency Medicine

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“…14 Direct visualization of a saddle embolus at the bifurcation of the pulmonary artery or an intracardiac embolus (clot-in-transit) can be seen, and indicates a higher risk of complications and death. 15 Direct visualization of intracardiac thrombi in the setting of a patent foramen ovale, which is associated with a risk of stroke, can prompt surgical embolectomy as an option for treatment in high-risk PE patients. 16…”

Section: Evidencementioning

confidence: 99%

Echocardiography in the Risk Assessment of Acute Pulmonary Embolism

Dahhan

Alenezi

Samad

et al. 2017

Semin Respir Crit Care Med

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Acute pulmonary embolism (PE) is a major cause of morbidity and mortality and is classified as massive (high risk), submassive (intermediate risk), or nonmassive (low risk) based on the hemodynamic status and clinical characteristics of the patient. At this time, the management of patients with submassive PE remains controversial and approaches for improving risk assessment are critical. In this review, we discuss several echocardiographic methods to assess right heart function that may aid in the risk assessment of patients with acute PE. They range from qualitative assessments of right ventricular (RV) function, such as subjective RV function and McConnell sign, to more recently developed quantitative parameters of RV function, such as tricuspid annular plane systolic excursion, RV/left ventricular ratio, and RV global and free wall longitudinal strain. Because of their reproducibility and objective nature, quantitative RV echocardiographic assessments have been gaining importance in the assessment of acute PE. Current limitations to the use of echocardiography for risk assessment in acute PE are the lack of normative values for RV parameters, the absence of standardization of measurements across different ultrasound platforms, and the heterogeneity of the performance of echocardiographic examinations and reports across centers.

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“…As such, it is worm-like in appearance and freely mobile within the heart chambers. 1 , 2 In contrast, Type B thrombus is considered to have originated within the atrium or ventricle, and tends to be firmly attached to the chamber wall. Type A thrombus is often more clinically significant as its mobility can markedly impede flow through the right heart, predisposing to rapid cardiovascular collapse and shock.…”

Section: Introductionmentioning

confidence: 99%

Bedside Echocardiography for Undifferentiated Hypotension: Diagnosis of a Right Heart Thrombus

Kenny

Zhong²,

Brown³

et al. 2015

WestJEM

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A free-floating right heart thrombus is often a harbinger of a massive pulmonary embolism and must be diagnosed and treated rapidly in order to avoid significant adverse sequelae. We present the case of an 84-year-old female who presented with two days of dyspnea and was hypotensive on arrival. Bedside ultrasound was performed by the emergency physician and showed a large, mobile right heart thrombus leading to immediate administration of a thrombolytic. In this case, bedside ultrasound was utilized to help further delineate clinical care in a progressively worsening patient, leading to a potentially lifesaving treatment.

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Diagnosis of Near-fatal Pulmonary Embolus-in-transit with Focused Echocardiography

Cited by 14 publications

References 24 publications

Extracorporeal cardiopulmonary resuscitation in bedside echocardiography–diagnosed massive pulmonary embolism

Extracorporeal cardiopulmonary resuscitation in bedside echocardiography–diagnosed massive pulmonary embolism

Echocardiography in the Risk Assessment of Acute Pulmonary Embolism

Bedside Echocardiography for Undifferentiated Hypotension: Diagnosis of a Right Heart Thrombus

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