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- W4385962777 abstract "A 71-year-old woman was found unresponsive at a rehabilitation facility and transported to the emergency department. Ambulance personnel intubated her, and an ECG revealed ST-segment elevation in leads II, III, and aVF with depression in aVL. The emergency physician performed resuscitative transesophageal echocardiography (Figures 1 and 2, Video 1).Figure 2Hyperechoic thrombus (asterisk) straddling LA and RA through an atrial septal defect (arrow). LA, left atrium; RA, right atrium.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Atrial septal defect with straddling thrombus resulting in a multi-system thromboembolic event. Transesophageal echocardiogram revealed a large thrombus (Figure 1, Video 1) straddling an atrial septal defect (Figure 2). Further investigations revealed septal flattening (“D” sign), right ventricular free-wall akinesis with sparing of the apex (McConnell sign), and an elevated right ventricular systolic pressure of 46 mmHg, all of which are indirect measures of pulmonary hypertension that are concerning for pulmonary embolism (PE).1Slama M. Maizel J. Pulmonary hypertension.in: McLean A. Huang S. Hilton A. Oxford Textbook of Advanced Critical Care Echocardiography. Oxford University Press, 2020Google Scholar, 2Parasuraman S. Walker S. Loudon B.L. et al.Assessment of pulmonary artery pressure by echocardiography-A comprehensive review.Int J Cardiol Heart Vasc. 2016; 12: 45-51PubMed Google Scholar, 3Fields J.M. Davis J. Girson L. et al.Transthoracic echocardiography for diagnosing pulmonary embolism: a systematic review and meta-analysis.J Am Soc Echocardiogr. 2017; 30: 714-723.e4Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar Computed tomography revealed multiple PEs. Although in the ICU, perfusion imaging demonstrated an occlusive thrombus in the left M1-MCA segment. Transesophageal echocardiography offers superior image quality when compared with transthoracic echocardiography and has far higher diagnostic accuracy for PE.4Saric M. Armour A.C. Arnaout M.S. et al.Guidelines for the use of echocardiography in the evaluation of a cardiac source of embolism.J Am Soc Echocardiogr. 2016; 29: 1-42Abstract Full Text Full Text PDF PubMed Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIxODk2ZjhhZGQ0YTQwODJkYWI5MThkZTgzNTZmNGE0ZiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjkyMzc5ODg3fQ.oCrgzbWJs1orEC3Ysx-CFlvq3vyPIVxPHlcTx-kYwRVNRAI2JyaUrVtrWjNaQA3TeMLZ6ALx2prpfpgWJFdFQfysYoSDtCD0uVrmtPQwrJdtbUoKJ2QtpWeRC-amSm_JUucr9gHUIU04Uv8RD7Xvf-fGpsUmrdLfBFz3qcPKG0-bFzQ5Z79lHMe0xtNZ0xhVsgCz5tK6L8lpINVFYdHQXrOXj2pERBodetPAsxmd-514vqhPojKlOgGkQxopz7wAMbnH-rKECnLw39i1dQcMEHPDWAGTwCme2X_AcL6W2AYGKWz5QM4h78ek5Kd2nptV5kkOLSq7OLcQ-1h1YCQI8g Download .mp4 (5.34 MB) Help with .mp4 files Video 1Transesophageal probe in the mid-esophageal bicaval view depicting transatrial septal defect thrombus (asterisk) straddling LA and RA through an atrial septal defect (arrow). LA, left atrium; RA, right atrium." @default.
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- W4385962777 date "2023-09-01" @default.
- W4385962777 modified "2023-10-05" @default.
- W4385962777 title "Woman Found Unresponsive at Rehabilitation Facility" @default.
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- W4385962777 doi "https://doi.org/10.1016/j.annemergmed.2023.03.024" @default.
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