[Diagnosis of severe pulmonary embolism by transesophageal echocardiography]

Diagnosis of right pulmonary artery embolism by transesophageal echocardiography. A case report

The authors report a case of a fifty-one-year-old man undergoing rehabilitation therapy following a stroke who suddenly developed right-sided pleuritic chest pain with dyspnea. Transesophageal echocardiography was used to demonstrate a nonocclusive right pulmonary artery embolus, when other investigative modalities failed to establish the diagnosis.

Diagnosis of main-stem pulmonary thromboemboli by transesophageal echocardiography

The aim of this report is to describe the usefulness of transesophageal echocardiography in the diagnosis of pulmonary emboli. A biplane transesophageal probe was used to examine the pulmonary artery in multiple views in three patients with suspected pulmonary emboli. The diagnosis of pulmonary emboli was made by transesophageal echocardiography in each of three patients when an echodense, circular or linear mass was seen in more than one view of the main or right pulmonary artery. In conclusion, our findings, coupled with previous case reports, suggest that transesophageal echocardiography should be considered in all critically ill patients with suspected pulmonary emboli.

[Arterial embolism caused by an intra-aortic thrombus or a patent foramen ovale? Diagnosis by transesophageal echocardiography]

This case report demonstrates the value of transoesophageal echocardiography (TOE) in comparison with transthoracic echocardiography as it allows a better view of the thoracic aorta, the auricles, the interauricular septum and the cardiac valves, especially in the intubated and ventilated patients. A 84-year-old woman was admitted to the ICU for hypoxia after carotid-subclavian bypass surgery for acute ischaemia of the left upper limb. The TOE showed a dilated right heart and a patent foramen ovale, compatible with pulmonary embolism as well as two thrombi in the aortic arch. The patient died on the 8th postoperative day from refractory hypoxia. the autopsy confirmed the pulmonary embolism and the intraaortic thrombi. It is concluded that TOE, readily feasible is indicated in case of hypoxia, shock and systemic embolism without cause immediately recognizable, especially in ventilated patients.

The diagnosis of a pulmonary artery thrombus by transesophageal echocardiography

We describe a patient with an acute inferior wall myocardial infarction who underwent percutaneous coronary angioplasty. He subsequently had a cardiac arrest and developed progressive severe hypoxia. Although findings from pulmonary angiography were nondiagnostic, transesophageal echocardiography demonstrated a nonocclusive, right pulmonary artery thrombus. Therapy was changed, and the patient recovered. Transesophageal echocardiography was also used to monitor anticoagulation therapy.

[Contribution of transesophageal echocardiography in intensive care: a prospective assessment]

The benefits of transoesophageal echocardiography (TOE) were assessed prospectively in intensive care patients. The doctors carrying out TOE were not the same as those who ordered it. TOE was performed in 32 patients, all of whom but one were intubated and artificially ventilated, to elucidate the cause of circulatory shock, or to search for valvular vegetations or an intracardiac mass. TOE confirmed the diagnosis previously obtained with pulmonary arterial catheterization (10 patients), transthoracic echocardiography (3 patients) or ventriculography (1 patient) in 54% of cases. In 28% of cases, TOE invalidated the suspected diagnosis, and, in the remaining 28% of patients, TOE invalidated provided a previously unsuspected diagnosis. TOE was particularly useful in confirming the presence of valvular vegetations, endocarditis, or intracardiac thrombi, and to assess left ventricular function and preload in patients in shock. Like others, this study confirms the benefits of TOE in the intensive care setting.

[Peroperative massive pulmonary embolism of tumoral origin. Value of extensive monitoring]

A case is reported of a 47-year-old female patient who suffered from massive tumour embolism during a nephrectomy for a renal carcinoma invading the inferior vena cava. Intraoperative monitoring consisted in direct blood pressure measurement (radial artery cannula), central haemodynamic monitoring (Swan-Ganz catheter), pulse oximetry and capnography. During the surgical manipulation of the suprahepatic vena cava, Petco2 suddenly decreased (from 25 mmHg to 14 mmHg), together with Spo2 (from 99% to 89%), and the mean pulmonary arterial pressure increased from 18 mmHg to 40 mmHg. The drop in arterial blood pressure to 50/30 mmHg, initiated an immediate sternotomy. After clamping the superior and inferior venae cavae, numerous tumour fragments were removed from the pulmonary artery. Cardiac activity restarted after internal cardiac massage, 1 mg adrenaline, 1 g calcium chloride and 150 mmol of molar sodium bicarbonate. The whole procedure lasted 30 min. Arterial blood pressure became stable at 110/50 mmHg, pulmonary arterial and wedge pressures at 20 and 5 mmHg. The Spo2 increased to 98%, and Petco2 to 25 mmHg. The nephrectomy was then carried out, the patient being given 5 micrograms.kg-1.min-1 dobutamine and 3 micrograms.kg-1.min-1 dopamine. At the end of surgery, systolic blood pressure was 120 mmHg, mean pulmonary arterial pressure 25 mmHg, and PaCO2 34 mmHg. The patient left the intensive care unit after twelve days. After one year of follow-up, no complication had occurred. The value of cardiopulmonary bypass in nephrectomy for renal carcinoma invading the vena cava, or the renal vein, is discussed.(ABSTRACT TRUNCATED AT 250 WORDS)