Previous studies have demonstrated the utility of bedside echocardiography in the ED. Bedside echocardiography is routinely used in the ED to diagnose pericardial effusion and assess global cardiac activity [1, 2].
Four cardiac views are frequently used in emergency ultrasound. The parasternal long (PSL) view includes the right ventricle (RV) anteriorly and LA and left ventricle (LV) posteriorly. The right atrium (RA) and the apical region of the LV are not well visualized in the PSL view. The parasternal short (PSS) view is most useful for the analysis of regional ventricular wall motion and global LV contractility. The subxiphoid view is the only satisfactory way to visualize the RA and it also affords the best view of the RV. The apical four view is useful for identification of all the chambers and symmetrically displays the mitral and tricuspid valves. This view is most useful for the assessment of apical region of the LV.
Advanced applications of emergency echocardiography include the assessment of aortic dissection, valvular dysfunction, regional wall motion abnormalities, and the identification of intracardiac masses . The differential diagnosis for intracardiac masses include thrombus, myxoma, and metastatic tumor. Thrombus is the most common cardiac mass. LV thrombi are associated with ventricular aneurysms while LA thrombi are associated with atrial fibrillation . Myxomas should be suspected if the mass is attached to the interatrial septum. Magnetic resonance imaging (MRI) is the diagnostic study of choice to distinguish thrombus from tumor .
This case demonstrates the utility of ED physician performing echocardiography to diagnose a dilated LA with a thrombus as the source of diffuse emboli. Bedside echocardiography expedited the diagnosis, patient care, and treatment.