Mitral Regurgitation - Dr. Josh Goldstein
A-FIB and Dyspnea on Exertion - Dr. Brian Knight
58yo M with PMH of A-fib comes in with worsening DOE and bilateral lower extremity edema. Some mild abdominal discomfort as well on physical exam.
-jellyfish sign (lung tip floating in pleural effusion) at start of the clip off to the left
-free fluid between spleen and diaphragm (pointed out with arrows in LUQ frame free fluid PDF)
-free fluid Morrison’s pouch
IVC Thrombus - Dr. Phillip Plevek
•26 yo F presents from pre-transplant (kidney) evaluation for abnormal echocardiogram
•Negative ROS, femoral dialysis catheter in place
•Hx of ESRD (FSGS), HTN, Anemia, Pancreatitis
Note the hyperechoic distal tip of the dialysis catheter in the IVC with a mobile, hypoechoic thrombus attached
•No signs/symptom of PE on arrival
•Started on Heparin, tunneled cath exchange after 3 days of A/C completed.
•CTA showed small asymptomatic subsegmental PE, continued on heparin drip
ATRIAL MASS - Dr. Ryan Lynch
59 yo male in minor MCC presents with chest pain and shortness of breath
XR shows 8 fractured ribs
PMH of BPD, pre-diabetes, HLD, polysubstance abuse
Difficult to distinguish mass vs thrombus on ultrasound by echogenicity
Most helpful distinguishing feature is presence or absence of stalk connecting abnormality to atrial wall as well as mobility
Thrombus more likely to have accompanying acute dyspnea or respiratory symptoms
Of primary cardiac tumors, atrial myxoma is most common and more often found on left
Secondary cardiac masses are 100 times more likely than primary and are usually found in right side of heart
Most require further imaging such as TEE, cardiac CT or MRI
Cardiac tumors can present with findings such as CHF 2/2 obstruction, PE, or even mimic tricuspid stenosis if found in RA like this patient
CARDIAC TAMPONADE - US Save by Dr. Sam Cochran
50s yo woman presents with generalized fatigue, tachycardia, and shortness of breath.
Note the circumferential effusion with diastolic collapse of the RV. Cardiology was consulted and the patient had an emergent pericardiocentesis. Great Save!