Mitral Regurgitation - Dr. Josh Goldstein

  • 62-year-old woman presents w/ 3 mo of gradually worsening SOB

  • Worse with exertion

  • No chest pain, fever, or history of cardiac/pulmonary disease

  • Vitals: HR 98 RR 16 BP 135/70 Temp 37.0 O2 96%

  • US: enlarged LA and MV regurgitation on color flow.

  • CT Surgery consulted and patient admitted for mitral valve replacement.


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.

LUQ clip:

-jellyfish sign (lung tip floating in pleural effusion) at start of the clip off to the left

-spine sign

-free fluid between spleen and diaphragm (pointed out with arrows in LUQ frame free fluid PDF)

RUQ clip:

-free fluid Morrison’s pouch

-spine sign


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!