Point of care ultrasound detection of thrombus straddling a patent foramen ovale in a patient with acute chest syndrome

Matthew Gorgone; Enrico M Novelli; Simmi Patel; Phillip E Lamberty; Laura M De Castro; Mark T Gladwin; Stephanie I Maximous

doi:10.1016/j.rmcr.2022.101724

Point of care ultrasound detection of thrombus straddling a patent foramen ovale in a patient with acute chest syndrome

Respir Med Case Rep. 2022 Aug 8:39:101724. doi: 10.1016/j.rmcr.2022.101724. eCollection 2022.

Authors

Matthew Gorgone¹, Enrico M Novelli², Simmi Patel³, Phillip E Lamberty¹, Laura M De Castro², Mark T Gladwin⁴, Stephanie I Maximous¹

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
² Section of Benign Hematology, Department of Medicine University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³ Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁴ Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Abstract

Patients with sickle cell disease can develop acute chest syndrome and are at high risk of developing pulmonary thrombosis. We report a case of a young woman with sickle cell disease who was hospitalized for vaso-occlusive crisis and subsequently developed worsening acute chest syndrome and stroke, discovered on point of care ultrasound to have right heart failure and a thrombus straddling a patent foramen oval. POCUS is highly specific for the detection of right heart dilation/dysfunction and should be a routine component of the assessment of acutely decompensating patients.

Keywords: Critical care; Paradoxical embolism; Point of care ultrasound; Sickle cell disease.

Publication types

Case Reports