Three-dimensional echocardiography in acute heart failure: Can and should we do it in the emergency department?

Despite its proven superiority over two-dimensional transthoracic echocardiography (2DTTE) for left ventricular (LV) volumes and ejection fraction, clinical use of 3DTTE remains very limited in the acute setting. 3DTTE may have significant clinical advantages in the assessment of acute heart failure. Further exploration of 3DTTE utilization may help in more precise assessment of the regional wall-motion abnormalities, early identification of acute ischemic from nonischemic LV dysfunction with a more precise approach to the AHF management. The use of other measures, especially the right ventricular and the left atrial assessment, and 3D strain methodology may further expand the potential future utility of 3DTTE in patients with new-onset HF.

Silent Manifestations of Disseminated Nocardia in a Renal Transplant Patient.

This case report describes a unique presentation of disseminated nocardiosis in a 45-year-old male transplant recipient who initially presented with acute left hip pain. Despite being asymptomatic for respiratory symptoms, the patient developed a fever and subsequently exhibited hypoxia. A diagnostic workup revealed a cavitary mass in the right upper lobe and multiple pulmonary nodules, confirming silent pulmonary nocardiosis. Concurrently, an MRI identified myositis and a possible abscess in the left hip musculature. Treatment involved a regimen including imipenem-cilastatin and linezolid, tailored for Nocardia species farcinica. This case underscores the importance of vigilant evaluation for metastatic infections in immunocompromised patients presenting with atypical symptoms, highlighting the necessity of imaging studies such as CT of the thorax for early detection of silent pulmonary involvement.

Emergency department-based 3D echocardiogram use: a case series.

BACKGROUND: Three-dimensional echocardiography (3DE) with real-time volumetric imaging can be a vital modality in clinical practice. Despite its potential, it remains underutilized in the acute care setting. CASE PRESENTATION: We present two cases describing the use of 3DE in the emergency department (ED) for acute heart failure (AHF) and discuss the potential benefits of routine use in acute care settings. CONCLUSIONS: Three-dimensional echocardiography offers unique information as it relates to cardiac structure and function, and can be valuable for diagnosis and clinical decision-making in the ED.