Moderator EMEDPA Posted December 31, 2019 Moderator Share Posted December 31, 2019 55 yr old meth user with pleuritic chest pain, tachycardia, tachypnea, and intermittent low sats. No edema. coarse lung sounds, but consistent with prior copd hx. D-dimer elevated. PE study done and negative. BNP 5000. admitted for presumptive new onset chf with only minimal findings on cxr. diuresed 6 liters over 48 hrs. Echo shows huge clot in LV with EF of 15%. Plan is anticoagulation and repeat echo in 3 months. 3 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted December 31, 2019 Share Posted December 31, 2019 (edited) No edema and minimal findings on CXR yet 6 L diuresed. Was all that fluid 3rd spaced? In the belly? Edited December 31, 2019 by ohiovolffemtp Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted January 1, 2020 Moderator Share Posted January 1, 2020 Great, a new thing for me to paranoid about when I do POCUS. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 1, 2020 Author Moderator Share Posted January 1, 2020 1 hour ago, ohiovolffemtp said: No edema and minimal findings on CXR yet 6 L diuresed. Was all that fluid 3rd spaced? In the belly? your guess is as good as mine.... Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 1, 2020 Author Moderator Share Posted January 1, 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933579/ Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted January 1, 2020 Share Posted January 1, 2020 7 hours ago, EMEDPA said: 55 yr old meth user with pleuritic chest pain, tachycardia, tachypnea, and intermittent low sats. No edema. coarse lung sounds, but consistent with prior copd hx. D-dimer elevated. PE study done and negative. BNP 5000. admitted for presumptive new onset chf with only minimal findings on cxr. diuresed 6 liters over 48 hrs. Echo shows huge clot in LV with EF of 15%. Plan is anticoagulation and repeat echo in 3 months. Studly work. 1 Quote Link to comment Share on other sites More sharing options...
Guest JMPA Posted January 2, 2020 Share Posted January 2, 2020 out 6 liter, how about ins? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 2, 2020 Author Moderator Share Posted January 2, 2020 12 hours ago, JMPA said: out 6 liter, how about ins? not much. Nl po fluids. Quote Link to comment Share on other sites More sharing options...
jtpas Posted January 15, 2020 Share Posted January 15, 2020 Just curious, why the dimer before the CTA? Sounds like a good story for PE, and I'd think he would have gotten a scan even if the dimer was negative. Cool case! Quote Link to comment Share on other sites More sharing options...
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