20 year old brought to the ED with altered mental status.
Hypotension, cold extremities, severely delayed capillary refill. Necrotic ulcer on palate
#POCUS
1/5
Hypotension, cold extremities, severely delayed capillary refill. Necrotic ulcer on palate
#POCUS
1/5
Tamponade was diagnosed. After pericardial tap, patient regained consciousness. However, skin remained cold and hypoperfused. MABP 62 with low pulse pressure.
Repeat #EchoFirst IVC, PSAx, PLAx, A4ch
2/5
Repeat #EchoFirst IVC, PSAx, PLAx, A4ch
2/5
Plethoric IVC + Severe biventricular dysfunction. Thick and "speckled" LV walls
*Although this was not confirmed by biopsy. This made me suspect myocardial infiltration
Low LVOT-VTI = Low CO
HV flow reversal and 100% pulsatile portal vein = Severe venous congestion
3/5
*Although this was not confirmed by biopsy. This made me suspect myocardial infiltration
Low LVOT-VTI = Low CO
HV flow reversal and 100% pulsatile portal vein = Severe venous congestion
3/5
Looking at CT scan, there are some hypodense areas on cardiac walls, again suggesting infiltration: 4/5
Microscopic examination of pericardial fluid revealed malignant CD56 (+) lymphocites
This was patient's ulcer (*with consent)
Final diagnosis: Natural killer/T-cell lymphoma
5/5
This was patient's ulcer (*with consent)
Final diagnosis: Natural killer/T-cell lymphoma
5/5
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