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Adult Female With Dyspnea
IMAGES IN EMERGENCY MEDICINE Michael E. Abboud, MD; Sarah E. Frasure, MD 0196-0644/$-see front matter Copyright © 2016 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2015.07.506
Figure 1. Lung ultrasonography with M-mode, demonstrating the “stratosphere” (also known as “barcode”) sign.
Figure 3. Chest radiograph demonstrating air between the parietal and visceral pleura (asterisks) and within the pericardium (arrow).
Figure 2. Apical 4-chamber cardiac view demonstrates right ventricular free wall collapse (arrow) during diastole (note the open mitral valve [asterisk]).
[Ann Emerg Med. 2016;67:318.] A 26-year-old woman with Marfan’s syndrome presented to the emergency department (ED) with 2 days of right-sided chest pain and shortness of breath. Vitals signs were unremarkable. Her physical examination result was notable for decreased breath sounds in the right lung fields. The emergency physician immediately performed point-of-care lung and cardiac ultrasonography (Figures 1 and 2) and obtained a chest radiograph (Figure 3) that confirmed the diagnosis.
For the diagnosis and teaching points, see page 328. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 318 Annals of Emergency Medicine
Volume 67, no. 3 : March 2016
Pediatric Readiness and Facility Verification 25. Husain A, Fuchs S. A national effort requiring local solutions: regionalization of pediatric emergency care. Clin Pediatr Emerg Med. 2014;15:79-88. 26. Schenk E, Edgerton E. A tale of two populations: addressing pediatric needs in the continuum of emergency care. Ann Emerg Med. 2015;65:673-678. 27. Alessandrini E, Varadarajan K, Alpern ER, et al. Pediatric Emergency Care Applied Research Network. Emergency department quality: an analysis of existing pediatric measures. Acad Emerg Med. 2011;18:519-526. 28. Alessandrini EA, Knapp J. Measuring quality in pediatric emergency care. Clin Pediatr Emerg Med. 2011;12:102-112.
328 Annals of Emergency Medicine
Remick et al 29. Glance LG, Osler TM, Mukamel DB, et al. Outcomes of adult trauma patients admitted to trauma centers in Pennsylvania, 2000-2009. Arch Surg. 2012;147:732-737. 30. Glance LG, Osler TM, Mukamel DB, et al. Impact of trauma center designation on outcomes: is there a difference between Level I and Level II trauma centers? J Am Coll Surg. 2012;215:372-378. 31. Brown JB, Stassen NA, Cheng JD, et al. Trauma center designation correlates with functional independence after severe but not moderate traumatic brain injury. J Trauma. 2010;69:263-269. 32. Phibbs CS, Baker LC, Caughey AB, et al. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med. 2007;356:2165-2175.
Volume 67, no. 3 : March 2016
Figure 1. Lung ultrasonography with M-mode, demonstrating the “stratosphere” (also known as “barcode”) sign.
Figure 3. Chest radiograph demonstrating air between the parietal and visceral pleura (asterisks) and within the pericardium (arrow).
Figure 2. Apical 4-chamber cardiac view demonstrates right ventricular free wall collapse (arrow) during diastole (note the open mitral valve [asterisk]).
[Ann Emerg Med. 2016;67:318.] A 26-year-old woman with Marfan’s syndrome presented to the emergency department (ED) with 2 days of right-sided chest pain and shortness of breath. Vitals signs were unremarkable. Her physical examination result was notable for decreased breath sounds in the right lung fields. The emergency physician immediately performed point-of-care lung and cardiac ultrasonography (Figures 1 and 2) and obtained a chest radiograph (Figure 3) that confirmed the diagnosis.
For the diagnosis and teaching points, see page 328. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 318 Annals of Emergency Medicine
Volume 67, no. 3 : March 2016
Pediatric Readiness and Facility Verification 25. Husain A, Fuchs S. A national effort requiring local solutions: regionalization of pediatric emergency care. Clin Pediatr Emerg Med. 2014;15:79-88. 26. Schenk E, Edgerton E. A tale of two populations: addressing pediatric needs in the continuum of emergency care. Ann Emerg Med. 2015;65:673-678. 27. Alessandrini E, Varadarajan K, Alpern ER, et al. Pediatric Emergency Care Applied Research Network. Emergency department quality: an analysis of existing pediatric measures. Acad Emerg Med. 2011;18:519-526. 28. Alessandrini EA, Knapp J. Measuring quality in pediatric emergency care. Clin Pediatr Emerg Med. 2011;12:102-112.
328 Annals of Emergency Medicine
Remick et al 29. Glance LG, Osler TM, Mukamel DB, et al. Outcomes of adult trauma patients admitted to trauma centers in Pennsylvania, 2000-2009. Arch Surg. 2012;147:732-737. 30. Glance LG, Osler TM, Mukamel DB, et al. Impact of trauma center designation on outcomes: is there a difference between Level I and Level II trauma centers? J Am Coll Surg. 2012;215:372-378. 31. Brown JB, Stassen NA, Cheng JD, et al. Trauma center designation correlates with functional independence after severe but not moderate traumatic brain injury. J Trauma. 2010;69:263-269. 32. Phibbs CS, Baker LC, Caughey AB, et al. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med. 2007;356:2165-2175.
Volume 67, no. 3 : March 2016