Case by Case Insights into Advanced Echocardiographic Diagnostics
Feroze Mahmood, MD
Published January 23, 2024 | Clinics in Medical Education
Issue 5 | Volume 1 | January 2025
A 50-year-old male with type 1 diabetes mellitus presented to emergency department with 3 days history of dyspnea, productive cough, fever, chills and nausea.
On evaluation:
- Vitals: BP 80/50, HR 120, SaO2 96% (NP 4L), RR 20
- The patient has diffuse crackles on bilateral bases. Chest xray shows right lower lung consolidation with air bronchograms.
What is your initial differential diagnosis?
Pump Dysfunction: Tamponade, Pulmonary embolism, Heart Failure
Tank (empty or compromised): Hemorrhage and hypovolemia, Pneumothorax
Pipes: Aortic Dissection, Deep vein thrombosis.
How can you narrow your differential diagnosis?
Key Points
The primary differentiating feature of absolute hypovolemia vs. vasodilatory shock on bed-side ultrasound is end-diastolic volume.
End systolic volume (“kissing papillaries”) are common to both, but in isolated vasodilatory shock end-diastolic volume is usually preserved.
Septic shock is a complex process and includes both absolute loss of intravascular volume from capillary leak and vasodilation.
Acute management of vasodilatory shock can still include volume administration, but volume is rarely sufficient in the absence of other therapy (e.g. addressing source of infection, antibiotics, vasoconstrictors).