Point-of-care Ultrasound Diagnosis of Pulmonary Embolism with Thrombus in Transit

Kahl, Nicolas; Gabriel, Christopher; Lahham, Shadi; Thompson, Maxwell; Hoonpongsimanont, Wirachin

doi:10.5811/cpcem.2018.11.40377

Cited by 10 publications

(13 citation statements)

References 7 publications

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“…In this report, the patient notably had an initial equivocal FOCUS assessment for the common echocardiographic findings of PE upon ED arrival, due in some degree to technically challenging cardiac windows. However, the definitive diagnosis of PE by visualization of a RHTh by EP-performed FOCUS, as is described in this case, is a notably rare occurrence [ 8 , 12 - 18 ]. Patients with PE and RHTh have been shown to have a significantly shorter duration of symptoms, which is consistent with our suspicions that our patient’s PE presentation was hyperacute and rapidly evolving as thrombi from the RHTh entered the pulmonary circulation [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The coexistence of a RHTh with PE carries an increased mortality risk necessitating aggressive management [ 8 - 11 ]. Previous reports have described the crucial role of EP-performed FOCUS to establish the diagnosis of RHTh [ 12 - 18 ]. We report a case in which EP-performed FOCUS facilitated the expeditious diagnosis and management of RHTh in transit associated with submassive PE.…”

Section: Introductionmentioning

confidence: 99%

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Right Heart Thrombus in Transit Diagnosed With Focused Cardiac Ultrasound in the Emergency Department

Kalivoda

Rodriguez

Cabrera

2020

Cureus

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The diagnosis of a right heart thrombus (RHTh) in transit associated with pulmonary embolism (PE) is an uncommon phenomenon with a high mortality rate. Timely recognition of RHTh with focused cardiac ultrasound (FOCUS) in cases of suspected PE is necessary for critical decision making in the emergency department (ED). We present a case of RHTh with submassive PE in which the patient underwent successful catheter-directed thrombolysis. This case report illustrates the significance of an emergency physician (EP) implementing FOCUS during the initial ED evaluation to rapidly diagnose RHTh in transit and initiate PE therapy without delay.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Right Heart Thrombus in Transit Diagnosed With Focused Cardiac Ultrasound in the Emergency Department

Kalivoda

Rodriguez

Cabrera

2020

Cureus

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“…[15,16] To date, there are no clinical guidelines regarding the management of a thrombus in transit. [17,18] It is associated with poor prognosis and mortality, as it manifests itself in the critically ill. [19] Both percutaneous and surgical approaches may be consider for extraction of such thrombus in transit [20]. However, our patient was too unstable for any of these considerations.…”

Section: Discussionmentioning

confidence: 99%

Thrombus in Transit and Impending Pulmonary Embolism Detected on POCUS in a Patient with COVID-19 Pneumonia

Kariyanna¹,

Hossain²,

Jayarangaiah³

et al. 2020

AJMCR

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Coronavirus disease 2019 (COVID-19) is a pandemic that started in China in December 2019 and carries a high risk of morbidity and mortality. To-date (4-22-2020) it affected over 2.6 million people and resulted in nearly 200,000 death worldwide mainly due to severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). Among the major underlying pathophysiologic mechanisms in COVID 19 is hypercoagulability, leading to increased risk for deep vein thrombosis and pulmonary embolism that contribute to increased morbidity and mortality. In this report, we present the case of a 55-year-old man who presented with COVID-19 pneumonia, and was found to have a thrombus in transit by routine point of care ultrasound (POCUS). While computer tomography (CT) angiography is the test of choice, the utilization of point of care ultrasound (POCUS) has gained traction as an adjunctive means of surveillance for the development of VTE in patients with COVID-19. In this report, we discuss the clinical utility of POCUS in diagnosing thrombus in transit in COVID 19 populations.

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“…Its mortality rate of 44.7 % is due to the obstructive shock that occurs once the thrombus occludes the pulmonary arteries [5]. This finding of thrombus in transit on TTE or POCUS can be present with or without other signs of right heart strain; such as interventricular septum bowing into the left ventricle or right ventricular systolic dysfunction [6]. As can be seen below, a mobile, echogenic figure in the right atrium passing through to the right ventricle.…”

Section: Discussionmentioning

confidence: 99%

A Case of Thrombus in Transit: Role of POCUS in Early Diagnosis of Pulmonary Thromboembolism

Kariyanna¹,

Celenza-Salvatore²,

Jayarangaiah³

et al. 2020

AJMCR

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Pulmonary embolism is a cause of significant morbidity and mortality. Thrombus in transit is defined on ultrasound as mobile echogenic material, temporarily located in the right heart chambers making its way to the pulmonary vasculature, which is highly diagnostic of pulmonary embolism. Point-of-care ultrasound (POCUS) places significant role in early diagnosis of thrombus in transit. Point-of-care ultrasound also avoids the need for subsequent computed tomography angiogram for diagnosis of pulmonary embolism. We present the case of 53-year-old male who presented with shortness of breath and was noted to have sinus tachycardia; thrombus in transit was diagnosed by point-of-care ultrasound and was subsequently confirmed through computer tomography angiogram of the pulmonary artery.

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Point-of-care Ultrasound Diagnosis of Pulmonary Embolism with Thrombus in Transit

Cited by 10 publications

References 7 publications

Right Heart Thrombus in Transit Diagnosed With Focused Cardiac Ultrasound in the Emergency Department

Right Heart Thrombus in Transit Diagnosed With Focused Cardiac Ultrasound in the Emergency Department

Thrombus in Transit and Impending Pulmonary Embolism Detected on POCUS in a Patient with COVID-19 Pneumonia

A Case of Thrombus in Transit: Role of POCUS in Early Diagnosis of Pulmonary Thromboembolism

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