Share your cool TEE / echo cases

[vector2]

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Let's do some echo:

Pretty much spot on. The gifs didn't capture the way I would've liked (they're kinda choppy), but if you squint real hard you'll notice in the 4ch color shot that there is a central jet and a highly, eccentric anteriorly directed jet. There ended up being a cleft plus myxomatous degeneration...

forums.studentdoctor.net

no point starting a new thread

 

[2buckchuck]

This looks like something substantial is occupying the pericardial space. The RV looks near-totally obliterated, the RA size is reduced. RA pressure > LA pressure with the septum pushed over, and in the second image it looks like some stuff is shunting over R->L.

I would bet this is in the pericardium as opposed to being elsewhere in the mediastinum pushing in.

In terms of how to manage this, the stuff in the pericardial space looks pretty solid - idk if a subxyphoid window could debunk enough to go to sleep to remove this whole thing. And if it’s tumor it’s probably real vascular and would bleed like crazy

The safest course would be awake peripheral VA ecmo or CPB initiation, then induce and go to sleep. Careful sternotomy, debulk etc. Treat it like a spooky anterior mediastinal mass.

 

[sevoflurane]

I'm unable to find the older echo thread. @sevoflurane do you know what happened to it? If we can find it I'll delete this post and put the clips in the old one


Anyway, pt is 50 something male. Hx of HTN, CAD with prior PCI maybe a year ago. Was doing fine last year but over the course of the last three to four months has progressively been getting more dyspneic with orthopnea and having symptoms of malaise. Finally couldn't take it anymore and checked himself into the hospital.

Surgeon wants to take him to OR for a procedure. He is quite dyspneic on 5-6L O2 satting 95, unable to lie flat, hypotensive to SBP 85-95 on no pressors but mentating well. He's received multiple liters of fluid over the last 48 hrs in the hospital.


What's going on? Anything else you want to know? How do you want to proceed?

I am all good starting a new thread. 👍🏽
OG tee thread is 10 years old.

Let's do some echo:

Let's do some basic Echo: This comes from my personal data base, so I hope you guys dig it. Med studs and residents first. Name 1-7

forums.studentdoctor.net

Great case, as usual.

 

[sevoflurane]

The fact that this guys is even talking is remarkable. Septum in the second image is very telling.

 

[medicine2wallstreet]

I want to know where the hell his right ventricle is.