Bedside Ultrasound Quiz Part 1: a 50 yr old man with dyspnea, acidosis, hepatitis and leg edema. #FOAMed, #FOAMer, #FOAMus

So last night, an interesting call from the ED about a 50 year old man who presented with a 3 week history of increasing dyspnea, leg edema, temp of 39,  a lactate of 3.9, an INR of 1.7, elevated LFTs and a WBC of 18, but a BP of 130/75.

Fortunately, I was dealing with a saavy ER doc with some POCUS capabilities, so he also told me he saw a pretty big IVC and he was a bit leery about giving fluids, though this looked like pretty severe sepsis with 3 or 4 affected organ systems…

So I asked him to hold fluids until I got there. Here is what POCUS found:

He revealed a past history of untreated hypertention, and a flu-like illness 3-4weeks ago.

What’s the diagnosis (-es) and management?

Answers & Clinical evolution in part 2 tomorrow!

 

cheers

 

Philippe

 

 

 

 

 

 

 

 

4 thoughts on “Bedside Ultrasound Quiz Part 1: a 50 yr old man with dyspnea, acidosis, hepatitis and leg edema. #FOAMed, #FOAMer, #FOAMus

  1. Ferdinando Vittone

    Looks like severe LV function impairment, apical LV thrombus, MR, pulmonary edema.
    Acute heart failure due to myocarditis?
    Requires anticoagulation, inotropes, possibly Cpap, cardiology/cardiac surgery consultation

  2. Clinically sounds like he is in cardiac failure with some infectious element going on.

    Distended IVC with essentially no variation with respiratory cycle. Lots of B lines in the lungs. LV function looks markedly reduced with what looks like a big thrombus inside? Biochemical hepatitis could be from cardiac failure.

    Possibly myocarditis of some cause, probably infectious given recent flu like illness?

  3. Aparna Namboothiri

    Is tehre pleural effusion along with B lines,LV Thrombus and decreased contactility?

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