Echo & Cardiac Imaging

Echo Quiz 2019

Echo Quiz 2019 - Round 2

Clinical Data: 62 year old female transferred to the ICU with acute onset breathlessness and hemodynamically unstable from the surgical ward on the third post-operative day of her non cardiac surgery.

Pre Op

3rd Post Op day

Acute Pulmonary Thromboembolism.

Whenever Pulmonary Embolism (PE) is suspected, the pretest probability for PE should be estimated or calculated using a validated pretest probability score (e.g., Wells score, Modified Wells score, or Modified Geneva score).

Wells criteria and modified Wells criteria: Clinical assessment for pulmonary embolism
Variables Points
Clinical symptoms of DVT (leg swelling, pain with palpation) 3
Other diagnosis less likely than pulmonary embolism 3
Heart rate >100 1.5
Immobilization (≥3 days) or surgery in the previous four weeks 1.5
Previous DVT/PE 1.5
Hemoptysis 1
Malignancy 1
Pre-test probability assessment
Traditional clinical probability assessment (Wells criteria)
High >6.0
Moderate 2.0 to 6.0
Low <2.0
Simplified clinical probability assessment (Modified Wells criteria)
PE likely >4.0
PE unlikely ≤4.0
DVT: deep vein thrombosis; PE: pulmonary embolism.
Data from van Belle A, Buller HR, Huisman MV, et al. JAMA 2006; 295:172.
Modified Geneva score
Variables Points
Risk factors
Age >65 years 1
Previous deep venous thrombosis or pulmonary embolism 3
Surgery under general anaesthesia or fracture of the lower limbs within one month 2
Active malignancy (solid or hematologic; currently active or cured within the last year) 2
Symptoms
Unilateral lower-limb pain 3
Hemoptysis 2
Signs
Heart rate 75 to 94 beats per minute 3
≥95 beats per minute 5
Pain on lower limb deep venous palpation and unilateral edema 4
Total points
Pre-test probability assessment
Low 0 to 3
Intermediate 4 to 10
High ≥11
From: Le Gal G, Righini M, Roy PM, et al. Ann Intern Med 2006; 144(3):165-71.

Approximately 30 to 40 % of patients with PE have echocardiographic abnormalities indicative of RV strain or pressure overload. RV Echocardiographic findings include:

  • Increased RV size
  • Decreased RV function
  • Tricuspid regurgitation
  • Abnormal septal wall motion
  • McConnell's sign (Regional wall motion abnormalities that spare the right ventricular apex)
Compiled by: Dr. Sunil Bohra, Associate Director

Winners are:

First Place: Dr. Madhukar Cheerla from Hyderabad.

Second Place: Dr. Jignesh Parikh from Pune.

Third Place: Dr. Vinayak from Bahrain.