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Postgraduate Education Corner: Ultrasound Corner |

Ultrasound Diagnosis of Shock in a Woman With Metastatic Renal Cell CarcinomaUltrasound Diagnosis of Shock

Lewis A. Eisen, MD, FCCP; Wojciech Janowski, MD; Ariel L. Shiloh, MD
Author and Funding Information

From the Division of Critical Care Medicine (Drs Eisen, Janowski, and Shiloh), Department of Medicine, Albert Einstein College of Medicine, Jay B. Langner Critical Care Service, Montefiore Medical Center, Bronx, NY.

Correspondence to: Ariel L. Shiloh, MD, Division of Critical Care Medicine, Montefiore Medical Center and The Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; e-mail: ashiloh@montefiore.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):e1-e3. doi:10.1378/chest.13-0964
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Extract

A woman in her fifties with recurrent, metastatic renal cell carcinoma, previously treated with a radical nephrectomy and transurethral resection of a bladder tumor, was admitted to the hospital for management of chemotherapy-induced weakness and malaise. The patient was anemic and required RBC transfusion. Worsening hematuria was attributed to a recurrent bladder mass.

On hospital day 3, a rapid response code was activated for sudden unresponsiveness. Upon arrival of the response team, the patient was noted to be pale, diaphoretic, and in acute hypoxic respiratory failure. The patient’s BP was 90/40 mm Hg, and heart rate was alternating between tachycardia and bradycardia. Oxygen saturation on 4 L nasal cannula was 80% to 85%. Response to verbal and noxious stimuli was absent. The patient’s breathing was rapid and labored, and the lungs were clear to auscultation. ECG demonstrated right-sided ST elevations and complete heart block. The patient was promptly intubated and transcutaneous pacing was initiated.

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Figures

Tables

Video 1

Bedside ultrasonography

Video 2

Bedside ultrasonography

Video 3

Bedside ultrasonography

Video 4

Bedside ultrasonography

Discussion Video

Ultrasound used to diagnose obstructive shock due to pulmonary embolism.

Video 5

Apical four-chamber view demonstrates a severely dilated right ventricle and atrium

Video 6

Subcostal view

Video 7

Dilated inferior vena cava with massive mobile thrombus in transit to the right atrium

Video 8

Fully compressible common femoral vein without evidence of DVT

Video 9

Pacemaker wire positioned at the apex of the right ventricle

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