POCUS #005

Aung Htay (edits by Viet Tran)

A 53 year old male presents with worsening dyspnoea for the last 20 days. It initially started with exertion only but now occurs at rest. He also complains of non pleuritic left sided chest pain with normal observations. As part of your examination you decide to use POCUS.

What does the echo show?

Normal LV systolic function.
No obvious RV strain or deviated septum.
RV systolic function reduced on visualisation.
No pericardial effusion.
Thrombus in distal pulmonary trunk extending to right pulmonary artery (PSAX Trunk image)!

You've loaded him with a therapeutic dose of clexane, calculate the wells score in your head and add on 100 points for the POCUS findings and organise a CTPA:

By the time it gets done, youve also got some of hte bloods back: 

• Troponin 121 ng/L (normal <15)
  
• NT BNP 840ng/L (normal<125)

So how bad is it doc?

Theres a few severity scoring systems around. 
In our shop this is classified as "Intermediate-high risk PE patients" given the fact that clinically there are no derangements

Should we thrombolyse?

Not at this stage. Despite the huge clot burden and biochemical and radiological evidence of right heart strain, this did not manifest into physiological or clinical concerns...

So what happened to him?

He was transferred to the HDU where he developed significant hypoxia without cardiovascular compromise and was therefore thrombolysed. 

An echo at 3 months showed normal LV and RV functions with no evidence of pulmonary hypertension.