Which finding on point of care echocardiography is most specific for pulmonary embolism?
Answer: Right heart thrombus in transit While only found in roughly 4% of patients who are investigated for pulmonary embolism, a thrombus in transit is a highly specific feature. It appears as an echogenic, highly mobile free-floating mass in the right ventricle, atrium, or inferior vena cava.
Left ventricle is underfilled and hyperkinetic. Severe right ventricular dilation and hypokinesis with marked paradoxical septal motion. Increased RV wall thickness and apical trabeculation. Right ventricular outflow tract dilated with reduced systolic excursion. Suggestion of mid-systolic notching of the right ventricular outflow waveform with pulsed wave Doppler.
Marked right atrial dilation with leftward deviation of the interatrial septum. At least moderate tricuspid regurgitation. No intraluminal thrombi visible. No evidence of pericardial effusion. Inferior vena cava is distended with minimal respiratory variability suggestive of increased right-sided pressures. Large volume ascites appreciable.
Overall suggestive of predominantly obstructive etiology to the acute circulatory failure.