Case 30

72 YO F w/ PMH significant for HTN, COPD, asthma, borderline DM
presents c/o dyspnea on exertion over the past several months, worse
in the last week. In ED, oxygen sat 98% on RA. Previous heavy tobacco
use, now discontinued.  Denies cough, CP, SOB, LE
swelling, f/c/n/v/d, abd pain, dysuria. No recent sick ctx/travel hx.

REVIEW OF SYSTEMS

CONSTITUTIONAL: (-) fever, (-) chills,
CARDIOVASCULAR: (-) chest pain, (-) palpitations,
RESPIRATORY: (-) cough, (+) SOB exertion, (-) SOB rest,
GASTROINTESTINAL: (-) pain, (-) nausea, (-) vomiting
MUSCULOSKELETAL: (-) back pain, (-) joint pain, (-) neck pain, (-) swelling.
INTEGUMENTARY: (-) abrasion(s), (-) rash.

EXAM
VS - T: 97F BP: 137/59 HR:75 RR:18 Oxygen: 98% RA

CONSTITUTIONAL: The patient is alert and in no apparent distress. Appears WDWN.
CARDIOVASCULAR: Regular rate and rhythm, heart sounds normal, no
gallops, rubs or murmurs, no edema present.
RESPIRATORY: Breath sounds clear, no distress present, no wheezing
rales, rhonchi or tachypnea. Normal rate and effort.
GI/ABDOMEN: Soft, non-tender, no organomegly, no pulsatile mass.
Normal bowel sounds.
MUSCULOSKELETAL/EXTREMITES: Non-tender, normal ROM, no pedal edema or
calf tenderness. NVT intact.
INTEGUMENTARY: Color normal for race, warm and dry, no rash.

LABS:
WBC - 5.47
Trop - <0.02
CK - 80
CKMB - 2.0
EKG - NSR@74bpm, nml axis, +PVCs, no acute ST changes

Questions:

  1. What do you see in the image below?
  2. What is the minimum numbers of views necessary to confirm your diagnosis?
  3. For the pathologic finding in this image, what is the minimal threshold for detecion by U/S?

Answers:

  1. Pericardial effusion
  2. A minimum of 2 views is necessary to confirm pericardial effusion on US
  3. 50 mL is the minimum threshold to see pericardial effusion on US
72 YO F w/PMH significant for HTN, COPD, asthma, borderline DM presents c/o dyspnea on exertion over the past several months, worse in the last week. In ED PT O2 sat 98% on RA.
Case #30B