Abstract
Background
Massive pulmonary embolism (PE) is a common consideration in unstable patients presenting
to the emergency department (ED) with chest pain, dyspnea, or cardiac arrest. It is
a potentially lethal condition necessitating prompt recognition and aggressive management.
Conventional diagnostic modalities in the ED, including chest computed tomography
angiography and ventilation-perfusion scanning, require the unstable patient to leave
the department, and raise concerns over renal injury. Several case reports document
findings of massive PE on echocardiography performed in the ED; however, none was
performed, interpreted, and acted upon in the form of thrombolytic therapy by an emergency
physician without the additional benefit of a cardiologist’s interpretation or a confirmatory
imaging study.
Objective
We present a case that illustrates the utility of ED focused bedside echocardiography
in suspected massive PE and briefly review direct and indirect ultrasound findings
of acute PE.
Case Report
A case of massive PE in a 61-year-old woman is reported. In this patient with marked
dyspnea, progressive hemodynamic instability, and contraindications to definitive
imaging, ED focused bedside echocardiography provided valuable information that strongly
suggested the diagnosis and led to alteplase administration. To our knowledge, this
case represents the first report of thrombolytic therapy administration for acute
massive PE based solely on clinical presentation and an emergency physician-performed
bedside echocardiogram.
Conclusion
In the hands of an experienced emergency physician ultrasonographer, ED focused bedside
echocardiography provides a safe, rapid, and non-invasive diagnostic adjunct for evaluation
of the patient suspected of having massive PE.
Keywords
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Article info
Publication history
Published online: August 05, 2011
Accepted:
May 20,
2011
Received in revised form:
October 30,
2010
Received:
September 10,
2010
Footnotes
Streaming videos: Two brief real-time ultrasound clips that accompany this article are available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clips 1 and 2.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
