title: Transesophageal Echocardiography Assisting in the Diagnosis of Intraabdominal Hemorrhage During Cardiac Arrest.
abstract: Transesophageal echocardiography (TEE) has been frequently used to identify potential etiologies of intraoperative cardiac arrest for noncardiac surgical patients. However, rescue TEE to assist in the diagnosis of intraabdominal hemorrhage has never been reported. We present a patient who developed cardiac arrest on emergence after an elective abdominal surgery. Intraoperative TEE revealed hypovolemia with hyperdynamic left and right ventricles. It also demonstrated a 3.3- by 13.2-cm circular perihepatic fluid collection on transgastric views raising concern for major intraabdominal hemorrhage as the cause for the cardiac arrest. This prompted surgical reexploration, which confirmed the diagnosis. We suggest that transgastric views to identify intraabdominal fluid collections should be considered during a rescue TEE if intraabdominal hemorrhage is suspected.
authors.affiliation: From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; and †Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Christina Anne
authors.initials: CA
authors.lastname: Jelly
authors.forename: Yandong
authors.initials: Y
authors.lastname: Jiang
authors.forename: Mark
authors.initials: M
authors.lastname: Hoeft
authors.forename: Yafen
authors.initials: Y
authors.lastname: Liang
mesh_terms: D000005:Abdomen / Q000473:pathology; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging*; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging