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Kidney Week

Abstract: SA-PO146

Cardiac Tamponade on Nephrologist-Performed Focused Cardiac Ultrasound

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Batool, Aisha, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Koratala, Abhilash, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction

Point of care ultrasonograhy (POCUS) has evolved as a component of physical examination in various specialties and nephrology is catching up quickly. Herein, we describe a case where focused cardiac ultrasound helped us appropriately manage AKI.

Case Description

A 59-year-old man with a history of untreated hypothyroidism presented with lower extremity swelling and shortness of Breath. Laboratory testing revealed a significantly elevated level of thyroid stimulating hormone of 43 mIU/mL (ref: 0.5-5). Chest X-ray showed an enlarged cardiac silhouette; transthoracic echocardiography demonstrated moderate to large circumferential pericardial effusion without tamponade and severely reduced LV systolic function. The patient was started on intravenous levothyroxine. The hospital course was complicated by hypotension requiring vasopressor therapy (presumed to be mixed septic and cardiogenic shock) and worsening renal function with oliguria. As assessing hemodynamics is a vital component of AKI evaluation, we performed POCUS, which revealed a plethoric inferior vena cava and a large circumferential pericardial effusion. Right ventricular diastolic collapse was clearly demonstrated (Figures 1 and 2) suggestive of tamponade physiology. The patient underwent emergent pericardiocentesis with removal of 450 mL of fluid resulting in cessation of the need for vasopressors as well as improvement in urine output.

Discussion

1. POCUS (not limited to kidney) aids in the management of AKI.
2. Hemodynamics are dynamic. Having a recent formal echocardiogram should not preclude POCUS.