1w cough and increasing dyspnea. Upon pickup by paramedics sat70%, hypotensive. ⬆️CRP/WBC. Pneumonia/septic shock assumed, abx and bolus fluids initiated, intubated in the ER. Hypotensive despite high dose pressor, #Echo follows #FOAMed #FOAMcc
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TEE showes papillary muscle rupture with torrential eccentric mitral regurgitation. Single lobe/lung pulmonary oedema can mimic pneumonia! #FOAMed #FOAMcc
Think this is more a victim of having the rare thing instead of the common thing. Septic shock 2/2 pneumonia is so much more common, and you got all your annoying sepsis goals that you only hit if you go hard down that pathway.
I think that’s right, but it’s being made worse by a monomanic focus on sepsis through campaigns etc. People are more scared of missing sepsis than misclassifying other kinds of shock as sepsis.
I don’t have the original images anymore (years ago) but as I recall that jet did an impressive tour of the atrial wall crossing over to the right side.
I am going through some of the presentations of the recent #Euroecho2024, and there was a case report similar to yours, with acute MR 2ndary to ruptured cord presenting as unilateral pulmonary oedema.
The patient came in during the night, reported at the internal medicine morning handover meeting as «septic, unresponsive to pressor», demonstrated that cxr and my cardiology boss said «that’s not pneumonia, that’s pulmonary oedema and went straight to the ICU to do the echo I showed.
saw similar very recently! cp + bioprosthetic avr awaiting redo. dyspnoea but maintaining spO2. cxr = R lung unilateral pulm oedema. BP ok, but cool, lac 6, aki 2, ALT 2000. TTE = new biventricular impairment, inferior/inferoseptal RWMAs, severe AR (prev moderate), new moderate-severe MR, vexus 3
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A bit puzzled how the eccentric (towards left sided pulmonary veins) MR can cause predominantly right sided lung congestion.
Have seen super nice tracing of giant v waves in R sided wedge but not left.