Diagnostic echocardiography in an unstable intensive care XXXX .

@entity1 @entity2293 @entity1353 @entity2294 @entity5 @entity2 @entity1003 @entity299 @entity591 @entity1167 @entity420 @entity1580 @entity1586
A previously fit and well 57-year-old gentleman who had recently undergone a colonoscopy and biopsy of a polyp presented with a 4-day history of progressive @entity1353 and abdominal discomfort. The day after admission, he became haemodynamically unstable, developed ischaemic legs and suffered a brief @entity1167 . Blood tests demonstrated a @entity1003 and hypoglycaemia. Continued haemodynamic instability post-arrest and clinical findings of high right-sided heart pressures were investigated by bedside screening echocardiogram. This demonstrated a massive @entity2294 causing tamponade of the right ventricle. Heavily blood stained pericardial fluid was drained, with marked improvement in haemodynamic stability. Retrospective review of the admission-electrocardiogram (ECG) and chest X-ray demonstrated electrical alternans and @entity299 . The differential diagnosis included @entity5 causing a haemorrhagic metastatic @entity2294 and a @entity1580 . Therefore a computerised tomography (CT) scan of chest, abdomen, pelvis and aorta was performed. This was negative for disseminated @entity5 and showed a @entity1580 , but was inconclusive for a @entity1580 . A subsequent transoesophageal echocardiogram confirmed the diagnosis of type B dissection and ruled out a type A dissection. The histology of the @entity1586 was negative for @entity5 , but it was subsequently discovered that the @entity1 had @entity420 from a primary @entity2 diagnosed from pleural fluid cytology. With hindsight the presenting clinical picture was of @entity1580 with concurrent but not directly related pericardial tamponade. LEARNING POINTS: Basic echocardiography skills are increasingly being used acutely by physicians' as part of resuscitative care in intensive care unit (ICU) @entity1 .The availability of expert skills in transoesophageal echocardiography are essential in ICU, as demonstrated in this case, where it was needed for discriminating between sub types of @entity1580 . @entity2293 is a clinical diagnosis, although the presence of electrical alternans on an ECG with associated @entity591 is highly suggestive of @entity2293 .
