The diagnosis of right heart thrombus by focused cardiac ultrasound in a critically ill patient in compensated shock

Abstract

Right heart thrombus (RHT) is a life-threatening diagnosis that is rarely made in the emergency department (ED), but with the increasing use of focused cardiac ultrasound (FocUS), more of these cases may be identified in a timely fashion. We present a case of an ill-appearing patient who had an immediate change in management due to the visualization of RHT soon after arrival to the ED. The diagnosis was confirmed after a cardiology-performed ultrasound (US). This case illustrates the value of the recognition of RHT on FocUS and how US protocols designed for the evaluation of shock and shortness of breath may potentially be expanded to patients in a ‘compensated’ or ‘pre-shock’ state to expedite the correct diagnosis and to facilitate more timely management.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-015-0023-7) contains supplementary material, which is available to authorized users.

Diagnostic Accuracy of Rapid Ultrasound in Shock (RUSH) Exam; A Systematic Review and Meta-analysis

“…In this study, the overall sensitivity of this method (for detection of shock type) is 88% and its overall specificity is 96%. Also, in this study, the type of shock 81% of patients were correctly diagnosed using the RUSH protocol, but 19% of patients were diagnosed as being mistaken [ 13 ]. In another study in 2013, Kappa's correlation coefficient for comparison of the RUSH 0.7 protocol has been calculated [ 14 ].…”

Asymptomatic Hypotension in a Patient with Catheter-related Right Atrial Thrombus

“…This is not the first case reported in literature using POCUS echocardiograms for visualization of right atrial thrombi; when used previously, the patients were in obvious states of end-organ hypoperfusion. 8 , 14 Here we present an unusual presentation of CRAT in an asymptomatic patient that highlights the importance of noting abnormalities in vital signs. Given CRAT’s high potential for morbidity and the relatively low risk and ease of obtaining a POCUS echocardiogram, we advocate that patients with a right heart catheter and vital sign abnormalities not attributed to another pathological state be evaluated in the ED for CRAT with a screening POCUS.…”

“…A similar case of “compensated shock” secondary to type A right heart thrombi has been reported previously in which a 50-year-old male was evaluated for bilateral leg pain and, due to his asymptomatic tachycardia, a POCUS echocardiogram was performed leading to the ultimate diagnosis. 8 …”

Acute Stroke in a Young Woman

“…In these circumstances, the expedited diagnosis provides obvious benefit to the patient. [4][5][6] In contrast, GDE is not commonly reported to be used to screen for left-sided cardiac sources of embolic events, with some reports identifying left ventricular thrombi and cardiac vegetations. 7,8 Guidelines for critical care ultrasonography recommend that GDE be performed to screen patients with suspected endocarditis because the intensivist with basic GDE training can recognize obvious cardiac vegetations.…”