{"id":1433,"date":"2019-12-24T23:42:02","date_gmt":"2019-12-24T23:42:02","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=1433"},"modified":"2020-07-21T23:52:26","modified_gmt":"2020-07-21T23:52:26","slug":"right-atrium-clot-2","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2019\/12\/24\/right-atrium-clot-2\/","title":{"rendered":"Case # 16: The Smoking Gun"},"content":{"rendered":"
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A 32 year-old woman with history of pleurisy and systemic lupus erythematosus presented to the emergency department with three weeks of shortness of breath and pleuritic chest pain, acutely worse one day prior to arrival.<\/p>\n

She flew into San Diego three days prior to her hospital presentation. She became dyspneic when walking from her hotel bed to the bathroom. On review of systems, she did endorse 3 weeks of right lower leg cramping. She denied fever\/chills, cough, back pain, or history of blood clots. She was tachypneic and speaking in short phrases upon arrival.<\/p>\n

Vitals: <\/span>T: 98.3, HR: 130, BP: 142\/88, RR: 24, SpO2 97% on RA<\/span><\/p>\n

A bedside ultrasound ECHO and lower extremity scan was preformed.  What do you see?<\/p>\n

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\"ezgif.com-video-to-gif\"<\/div>\n<\/div>\n
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\"RV<\/div>\n<\/div>\n<\/div>\n
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\"dvt<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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Answer and Learning Points<\/h3>
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Answer<\/strong><\/p>\n

These ultrasound images show an apical 4 chamber and parasternal short view of the heart, as well as a right lower extremity DVT. The apical 4 chamber demonstrates right ventricular dilation with bowing of the septum into the left ventricle. The parasternal short illustrates \u201cD sign\u201d with right ventricular dilation and bowing\/flattening of the interventricular septum leading to decreased left ventricular systolic function. Both views indicate right heart strain in the setting of likely pulmonary embolism. The right lower extremity showed a noncompressible right femoral vein, indicating DVT. <\/span><\/p>\n

TPA was prepared and ready to give incase patient had worsening hemodynamic instability. She was fortuantley able to tolerate further imaging without HD compromise; CT angio confirmed the diagnosis of pulmonary embolism in bilateral main pulmonary arteries extending into all 5 lobes. Half dose TPA was administered and the patient was admitted to the ICU.<\/span><\/p>\n

Learning Points<\/strong><\/p>\n