The diagnosis of right heart thrombus by focused cardiac ultrasound in a critically ill patient in compensated shock

Mansour Jammal; Peter Milano; Renzo Cardenas; Thomas Mailhot; Diku Mandavia; Phillips Perera

doi:10.1186/s13089-015-0023-7

The diagnosis of right heart thrombus by focused cardiac ultrasound in a critically ill patient in compensated shock

Crit Ultrasound J. 2015 May 13:7:6. doi: 10.1186/s13089-015-0023-7. eCollection 2015.

Authors

Mansour Jammal¹, Peter Milano², Renzo Cardenas², Thomas Mailhot², Diku Mandavia², Phillips Perera¹

Affiliations

¹ Division of Emergency Medicine, 300 Pasteur Drive, Alway Building, M121, Stanford, CA 94305 USA.
² Department of Emergency Medicine, Los Angeles County + USC Medical Center, 1200 N. State St # 1011, , Los Angeles, CA 90033 USA.

Abstract

Right heart thrombus (RHT) is a life-threatening diagnosis that is rarely made in the emergency department (ED), but with the increasing use of focused cardiac ultrasound (FocUS), more of these cases may be identified in a timely fashion. We present a case of an ill-appearing patient who had an immediate change in management due to the visualization of RHT soon after arrival to the ED. The diagnosis was confirmed after a cardiology-performed ultrasound (US). This case illustrates the value of the recognition of RHT on FocUS and how US protocols designed for the evaluation of shock and shortness of breath may potentially be expanded to patients in a 'compensated' or 'pre-shock' state to expedite the correct diagnosis and to facilitate more timely management.

Keywords: Bedside ultrasound; Cardiac ultrasound; Echocardiography; Focused cardiac ultrasound (FocUS); Pulmonary embolus; RUSH exam-rapid ultrasound in shock exam in the critically ill patient; Right heart thrombus; Ultrasound in shock; Ultrasound in shortness of breath.