Right Ventricular Dysfunction - D-Shaped Septum
Caption
A 56-year-old female with history of metastatic breast cancer presented with acute shortness of breath. Physical examination was notable for hypotension, sinus tachycardia, raised JVP, and mild respiratory distress. There was no evidence of lower extremity edema and chest xray was unremarkable. POCUS showed no B lines on lung views. Cardiac views (seen here) were notable for a hypokinetic and dilated RV with flattening of the interventricular septum creating a D shaped LV during systole. These findings are consistent with high right ventricle and pulmonary artery pressures in the absence of pulmonary artery stenosis. Specifically, a D-shaped LV during diastole reflects RV volume overload; a D-shaped LV during systole reflects RV pressure overload. RV pressure overload can be seen in massive and submassive pulmonary embolism (PE) and this patient was diagnosed with a submassive PE; findings confirmed by CT angiography. In this instance, POCUS enabled prompt diagnosis and early initiation of therapeutic anticoagulation. Shahad Al Chalaby, MD. Highland Hospital. Alameda Health System Internal Medicine Residency Program. California, USA. shahad_Chalaby Katherine Farley, OMS4. Touro University. California, USA.