Technical: The bedside ultrasound study was performed with a GE Healthcare Vscan ultrasound system.
Presentation: A 22-year-old male arrived at the Emergency Department around midnight, complaining of chest pain and shortness of breath. It was his second visit to the ED in as many weeks; just 14 days earlier, he had come in with a respiratory infection, which was treated with antibiotics. The patients malaise and fatigue had continued, however. He presented the second time in severe distress. He had no nausea, vomiting or fever, but in addition to the chest pain and dyspnea, he had a rash on his extremities. Because his symptoms were worsening, with increasing dyspnea, tachycardia and a rise in blood pressure to 172/102, we decided to perform a bedside ultrasound
Caption: Figure 1. Subxiphoid view of the heart
Description: A thin layer of fluid is seen around the heart suggesting pericardial effusion
Caption: Figure 2. Short Parasternal view of the heart
Description: This view more clearly demonstrates the pericardial effusion, surrounding right and left ventricles.
Caption: Figure 3. Long Parasternal view of the heart
Description: Here the pericardial effusion is seen surrounding the cardiac silhouette.
Caption: Figure 4. Apical four chamber view of the heart
Description: This view demonstrates both anterior and posterior pericardial effusion
Discussion: The bedside study performed with a hand-held ("pocket") ultrasound system showed moderate pericardial effusion. A surgeon was consulted, and the patient was transferred directly to the main hospital for possible pericardial window. After his transfer, his condition rapidly deteriorated to cardiac tamponade. However, an emergency pericardial window was successfully performed. The diagnosis ultimately included pericarditis with secondary diagnoses of lupus, pneumonia and sepsis.
Differential: acute respiratiory infection, pneumonia, pulmonary embolism, pneumothorax, acute pericarditis, pericardial effusion, cardiac tamponade
Final: pericarditis with secondary diagnoses of lupus, pneumonia and sepsis
Follow up: The patient was successfully treated for the diagnosed conditions and discharged to home care without further complications.