The Use of Bedside Ultrasound in the Evaluation of Patients Presenting with Signs and Symptoms of Pulmonary Embolism

Abstract

Evaluation of patients that present to the emergency department with concerns for the diagnosis of pulmonary embolism can be difficult. Modalities including computerized tomography (CT) of the chest, pulmonary angiography, and ventilation perfusion scans can expose patients to large quantities of radiation especially if the study has to be repeated due to poor quality. This is particularly a concern in the pregnant population that has an increased incidence of pulmonary embolism and may not be able to undergo multiple radiographic studies due to fetal radiation exposure. This paper presents a case of a pregnant patient with signs and symptoms concerning pulmonary embolism. The paper discusses the use of bedside ultrasound in the evaluation of patients with pulmonary embolism.

Point‐of‐care ultrasound with pocket‐size devices in emergency department

“…McConnell sign is defined as hypo/akinesis of the right ventricular free wall with hyperdynamic motion of the right ventricular apex, D‐shaped left ventricle refers to left ventricular shape in parasternal short‐axis caused by flattening or bowing of the intraventricular septum into the left ventricle due to acute pulmonary pressure overload. The specificity of sonographic findings of pulmonary embolism has been shown to be higher than the sensitivity . Right ventricular dilatation with D‐shaped left ventricle, right heart thrombus, McConnell's sign, and deep vein thrombosis can be detected by ultrasound examination performed with handheld devices.…”

“…63 There are multiple sonographic findings that support the diagnosis of acute pulmonary embolism and can be broken down pulmonary embolism has been shown to be higher than the sensitivity. 64 Right ventricular dilatation with D-shaped left ventricle, 40 right heart thrombus, 65 McConnell's sign, 66…”

Focused transthoracic echocardiography in obstetrics

“…The patient recovered well after a prolonged intensive care stay. Case study 3: pulmonary embolism 15 A young woman was transferred to an emergency department for further evaluation of symptoms suggestive of pulmonary embolism. She was 20 yr of age, parity one, and 22 weeks pregnant.…”

“…The specificity of ultrasound evidence of pulmonary embolism was high but sensitivity was low. 15 Thus, a repeat CT scan was performed, this time with good images, ruling out pulmonary embolism. Upon further questioning, the patient confirmed taking regular aspirin for toothache.…”