Case by Case Insights into Advanced Echocardiographic Diagnostics
Feroze Mahmood, MD
Published December 2, 2024 | Clinics in Medical Education
Issue 4 | Volume 1 | November 2024
A 41 year old male is s/p post laparoscopic esophagectomy. On evaluation, the patient is tachypneic and desturated to 50% on room air and 80% on 10 L of facemask.
ABG: 7.45/41/58/29/ +3
What is your initial differential diagnosis?
How can you narrow your differential diagnosis?
Key Points in Pulmonary Embolism
- Acute, hemodynamically significant PE frequently involves both lungs (saddle embolism). Difficult diagnosis and requires integration of all available information and high index of suspicion.
Typical US findings include RV Dilation with poor contractility. Apical function may be relatively preserved (Mc Connell’s sign) but this finding is erratic and of little diagnostic relevance.
LV hyperdynamic and underfilled.
Source of clot may not be apparent but finding of DVT in addition to the above signs, strongly supports a diagnosis of PE.
Large pneumothorax may cause similar TTE findings.
Thrombolysis can be life saving but will more than triple the risk of intracranial hemorrhage over therapeutic anticoagulation.