As I have reported in this blog, the staff at MTC care for many patients with complex and advanced pathology, including many cardiac cases, which prompted our echocardiography training course. Since our course, the participants have become adept at obtaining excellent echocardiogram images and have diagnosed a myriad of abnormalities. Recently, two interesting cases were seen. The images below were obtained by MTC staff who previously took our ECHO course.
Case 1:
37 yo M with a history of daily alcohol use presents with several months of shortness of breath and several weeks of lower extremity edema, with both symptoms worsening over the past few days. He denies significant past medical history, takes no medications, and has no known history of cardiac abnormalities.
The image below is what a normal heart looks like in a parasternal long view from the Core Ultrasound website (this is NOT our patient)
The following echocardiogram images are from our patient
Parasternal Long Axis showing dilated cardiomyopathy with severely reduced ejection fraction
Parasternal Short Axis showing dialated cardiomyopathy, severely reduced ejection fraction, small pericardial effusion (fluid around the heart), and a possible thrombus (blood clot) that formed due to low blood flow state as a result of the reduced ejection fraction.
Apical 4-Chamber view showing tricsupid valve regurgitation (the blue jet visible due to the color doppler)
Inferior Vena Cava (IVC) view showing plethoric (enlarged) IVC which is a result of increased central venous pressure secondary to the dilated cardiomyopathy
Case #2
30 yo F with a history of a molar pregnancy one year ago, presents with shortness of breath and chest discomfort for several weeks. Given her symptoms, the MTC clinical staff quickly performed an echocardiogram and found the following significant findings. This patient was immediately transferred to Mae Sot General Hospital for further evaluation and treatment. The ability to perform diagnostic tests to identify life-threatening pathology to provide the correct treatment or transfer the patient in a timely manner is critical to MTC's mission. The MTC clinical staff evaluated this patient, and the ECHO was performed by one of our course graduates who initiated the transfer while we were running our recent Basic Emergency Care course, so I did not evaluate the patient myself.
This apical four chamber ECHO view shows a massive ventricular abnormality thought to likely be a large thrombus (blood clot) or possibly a large mass such as an intracardiac tumor. We are awaiting follow up from Mae Sot General Hospital on the final diagnosis and outcome.