Instant Pulmonary Embolus and Deep Vein Thrombosis Diagnosis Through Point-of-Care Ultrasound in a Patient Diagnosed With Sepsis Due to a Urinary Tract Infection.

Pulmonary embolus (PE) is a life-threatening illness that can be fatal if not treated with anticoagulation in a timely fashion. Without the use of CT angiography for direct visualization of thrombus in the pulmonary arteries or downstream vessels, the diagnosis of a PE can be challenging. Point-of-care ultrasound (POCUS) is a bedside method that is highly effective in directly evaluating deep vein thrombosis (DVT) and indirectly evaluating PE. In this case, a patient presented to the hospital with hypotension from a presumed urinary tract infection and was treated with intravenous fluids and antibiotics. POCUS examination revealed significant right heart strain and femoral DVT despite negative imaging one week prior. This highlights the importance of POCUS in evaluating patients with cardiopulmonary disease.

Instant Endocarditis Diagnosis Using Point-of-Care Ultrasound (POCUS) in a Patient Diagnosed With Pneumonia.

Acute bacterial endocarditis is an acute febrile illness that spreads hematogenously and can be fatal if it is not treated in a timely fashion. A traditional physical examination has very limited sensitivity and specificity when diagnosing bacterial endocarditis. Point-of-care ultrasound (POCUS) during the physical exam can assist with the diagnosis by evaluating for valvular regurgitation or visible vegetation. In this case, a patient presented to the hospital with a cough and shortness of breath and was diagnosed with pneumonia. She did not improve with intravenous antibiotics and a POCUS exam revealed the diagnosis was in fact bacterial endocarditis and not pneumonia. This led to further imaging, which revealed an abdominal abscess. This highlights the importance of incorporating POCUS into the physical exam of any patient presenting with cardiopulmonary symptoms.

A Novel Method for Estimating Right Atrial Pressure With Point-of-Care Ultrasound.

BACKGROUND: Current noninvasive estimation of right atrial pressure (RAP) by either bedside jugular venous pressure exam or inferior vena cava measurement during a comprehensive echocardiogram offers imprecise estimates of actual RAP. METHODS: We enrolled 41 patients in a prospective, blinded study to validate a novel point-of-care ultrasound method using direct right atrial depth (RAD) measurement and jugular venous ultrasound to estimate RAP. Two subjects were excluded, and 39 were included in the final analysis. A parasternal long-axis view was obtained, and the depth of the noncoronary cusp attachment to the posterior left ventricular outflow tract was recorded as the RAD. This was added to an estimate of the jugular venous pressure obtained during a jugular vein ultrasound to calculate an estimated RAP (RAPUS). The RAPUS was compared to the RAP measurement during right heart catheterization (RAPcath) both as measured and as corrected for where the catheter was zeroed. RESULTS: The correlation coefficient between RAPcath and RAPUS was +0.75; regression R2, 0.56; and bias, -0.49 mm Hg (95% CI, -1.42 to +0.43 mm Hg), with the limits of agreement -5.56 to +7.24 mm Hg and accuracy of 3 mm Hg or less in 29 (74%) of the subjects. For the RAPUS corrected for the catheter zero point, the correlation coefficient between RAPcath and RAPUS was +0.72; regression R2, 0.52; and bias, -0.60 mm Hg (95% CI, -1.60 to +0.39 mm Hg), with the limits of agreement -5.56 to +7.24 mm Hg and accuracy of 3 mm Hg or less in 26 (67%) of the subjects. CONCLUSION: This simple ultrasound evaluation of RAD and the right jugular vein correlates well with actual RAP and can accurately estimate RAP within 3 mm Hg in most patients. This has the potential to improve our bedside volume status exam, as well as improve the accuracy of RAP estimation during comprehensive echocardiogram.

Severe Mitral Regurgitation Diagnosis Through Point-of-Care Ultrasound During Initial Physical Examination.

Mitral regurgitation is a common valvular disorder found in the general population with varying degrees of severity. The symptoms of this disorder correspond to the severity of regurgitation as well as its associated complications such as arrhythmias. Suspicion of mitral regurgitation is based on physical exam findings with diagnosis generally requiring confirmatory findings on transthoracic echocardiogram. However, asymptomatic patients with mitral regurgitation and limited sensitivity of cardiac auscultation to detect a murmur confound the diagnosis. In this case, a patient presented with nonspecific symptoms of shortness of breath and abdominal pain in which a bedside point-of-care ultrasound (POCUS) in initial examination demonstrated severe mitral regurgitation and pulmonary edema. These findings expedited an intervention on the regurgitation, which highlights the importance of incorporation and early use of POCUS during physical examination.

Instant Heart Failure Diagnosis Using Point-of-Care Ultrasound (POCUS) in a Patient Incorrectly Diagnosed With Asthma.

Congestive heart failure is one of the most common causes of hospitalization in the United States, yet it often goes undetected due to the poor sensitivity of chest X-rays for detecting pulmonary edema. In this case, a patient presented with one year of shortness of breath and a diagnosis of asthma; however, a three-minute point-of-care ultrasound (POCUS) exam revealed that the correct diagnosis was in fact congestive heart failure. This highlights the importance of incorporating POCUS into the physical exam of any patient presenting with cardiopulmonary symptoms.