title: New onset right ventricular enlargement in recent dyspnea: Is echocardiography enough for a diagnosis of pulmonary thrombo-embolism?
abstract: Pulmonary embolism may be often promptly diagnosed just by bedside echocardiography, in the case of new onset severe right ventricular enlargement, increased pulmonary pressure and dyspnea. However, CT confirmation could be required in the presence of contrasting findings during diagnostic work up. We report the case of a 79-year old woman who presented with acute dyspnea, right ventricular enlargement and leftward septal shift. Despite first diagnosis of pulmonary embolism, an irregular mass was detected at CT scan in mid left lung, apparently infiltrating left pulmonary artery branches, without signs of evident pulmonary thrombo-embolism. Visceral pleural and lymphonodular infiltration suspected for malignancy was also present. We hypothesize that acutely increased pulmonary pressures and enlarged right ventricle were caused by the infiltrating pulmonary mass, presumably a lung tumor, partly involving left pulmonary artery branches and by tumor pulmonary embolism. A diagnosis of pulmonary thrombo-embolism exclusively based on echocardiography may be occasionally misleading without a careful diagnostic work-up.
authors.affiliation: Cardiology Department, Ospedale S. Paolo, Bari, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: De Gennaro
authors.affiliation: Cardiology Department, Ospedale S. Giacomo, Monopoli, Bari, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Giannoccaro
authors.affiliation: Cardiology Department, Ospedale S. Giacomo, Monopoli, Bari, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lopriore
authors.affiliation: Cardiology Department, Ospedale S. Paolo, Bari, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Caldarola
authors.affiliation: ASL Bari, Bari, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lentini
authors.affiliation: Cardiology Department, University of Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
authors.affiliation: Cardiology Department, University of Foggia, Italy. Electronic address: natale.brunetti@unifg.it.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
mesh_terms: D000368:Aged; D003951:Diagnostic Errors; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000209:etiology*; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
keywords: CT scan; Echocardiography; Lung tumor; Pulmonary embolism; Right ventricular enlargement