Cardiac Tamponade as an Unusual Manifestation of Primary Heart Tumor

Abstracts Emergency P 138 ee Cardiac Tamponade as an Unusual Manifestation of Primary Heart Tumor F. Chen Division of Cardiovascular Center, Department of Medicine, Show Chwan Memorial Hospital, Changhua/TW Learning Objectives: Management of cardiac tamponade should be directed toward urgent pericardiocentesis, but it is unsuitable to perform soft tissue compression. When urgent tamponade is diagnosed, intravenous hydration should be instituted, especially if patients had mistakenly received diuretic because of an incorrect diagnosis of congestive heart failure in our case. Background: A 42-year-old previously healthy man presenting with cough, progressive exertional dyspnea, chest pain, and cold sweating visited our emergency department. Physical examination demonstrated a rapid irregular pulse, blood pressure of 84/42 mmHg, bilateral low lung moist rales and distant heart sounds, jugular venous pressure of 16 cm water. A chest film showed increased heart size and redistribution of lung marking consistent with interstitial pulmonary edema. Initially, he was diagnosed with congestive heart failure and some inotropic agent and low dose diuretic were prescribed. Progressively worsened shock and heart collapse followed. Echocardiography showed a huge mass surrounding the epicardium causing tamponade of the left ventricle. Imaging Findings or Procedure Details: 1.Apical two-chamber view of echocardiography showed a huge mass inside the pericardium causing tamponade of the left ventricle. 2. A 64-slice CT showed a huge heterogeneous mass about 15 cm in length with hematoma formation and contrast enhancement in the posterior heart portion, inside the pericardium causing left ventricle compression. Conclusion: In conclusion, we emphasize the rarity of this uncommon heart mass. Also, MSCT is such a valuable tool for the early diagnosis of the ‘‘triple triad’’ (aortic dissection, pulmonary embolism and coronary artery stenosis). P 139 se The Presence or Absence of Cardiac Movement Identified on PreHospital Echocardiography Predicts Outcome in Cardiac Arrest Patients P. M. Zechner,1 G. Aichinger,2 G. Prause,3 G. Wildner,3 J. C. Fox4 1 Department of Internal Medicine, LKH Graz West, Graz/AT, 2LKH Villach, Villach/AT, 3Department of Anesthesiology, Medical University of Graz, Graz/AT, 4Department of Emergency Medicine, University of California/Irvine, Irivne/US Purpose: To determine the ability of preHospital emergency echocardiography to predict survival in cardiac arrest patients at the scene. Material & Methods: All participating emergency physicians (n 5 24) received a 4-h course in focused echocardiography including 1 h of theoretical basics, 1 h of video demonstrations and 2 h of hands-on training. After obtaining standard procedures such as defibrillation, intubation and vascular access, a focused ultrasound was performed during the pulse check according to the FEEL algorithm described by Breitkreutz et al. Patients were divided into movement and no-movement groups. Sonographic evidence of movement was defined as any motion of the myocardium, ranging from visible ventricular fibrillation to coordinated ventricular contractions. CPR had to be continued for at least 15 min after the initial echocardiography according to recent AHA guidelines and no decisions were made based on the results of ultrasound. Results: We enrolled 40 patients in the study. Thirty patients had no movement on echocardiography. One patient of the no movement group (3%) versus four patients of the movement group (40%) survived until Hospital admission (p , 0.05). Cardiac standstill on echocardiogram re-

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sulted in a positive predictive value of 96.7% for death at the scene with a negative predictive value of 40%. Conclusion: The absence of cardiac movement on preHospital ultrasound may help predict adverse outcome in cardiac arrest patients. Larger studies are needed before any conclusions about ending resuscitative efforts prematurely can be made. P 140 se Radiologic Assessment of Rwandan Imaging Capacity and Outcomes R. E. Gerber,1 J. F. Calland,2 R. T. Petroze,2 E. Rudakemwa,3 C. Moshi,4 J. Ngenzi,5 K. S. Rheuban,6 W. E. Brant1 1 Department of Radiology, University of Virginia, Virginia 22908/US, 2 Department of Surgery, University of Virginia, Charlottesville/US, 3 Department of Radiology, King Faisal Hospital, Kigali/RW, 4 Department of Radiology, Central University Teaching Hospital in Kigali, Kigali/RW, 5It Department, Kigali Health Institute, Kigali/RW, 6 Department of Telemedicine, University of Virginia, Charlottesville/US Purpose: The complex imaging climate in resource-limited settings is not easily navigable. The goal of this study is to provide a radiologistoriented, baseline needs assessment to increase radiologic capacity, develop technical infrastructure and improve medical education in Rwanda. Material & Methods: We conducted an on-site, 1 month descriptive study of radiologic needs using the RAD-AID survey tool. We hypothesized that Rwandan Hospitals vary regarding ultrasound and non-ultrasound imaging volume and range, equipment availability and functionality, and extent of personnel and training. Results: Data were collected from 14% of government district (6/42) and 100% of referral Hospitals (2 University teaching, 1 tertiary referral); 100% of surveyed Hospitals had at least one functional ultrasound and radiograph machine, but 44% (4/9) reported at least one broken ultrasound. Referral Hospitals had increased volume and range of studies. CT and MRI were available at the tertiary referral Hospital only. All referral Hospitals had a full-time radiologist; however, general practitioners were primary interpreters at district Hospitals. Additional differences regarded training, ongoing education, digital/telemedicine capability and future development plans. Conclusion: Current radiologic capacity is markedly limited in Rwanda and will require substantial development for mature health-care infrastructure. Ultrasound has been and will continue to be an invaluable diagnostic modality, particularly at the district Hospital level. Radiologist-based outreach is crucial for a sophisticated imaging climate accounting for variable levels of need in resource-limited settings. P 141 se Diagnistic Value of Ultrasound in Mobile Railway Clinic in the European North of Russia M. S. Mogutov, A. N. Sencha, Y. N. Patrunov, D. V. Belyaev, Y. M. Pyatakov Ultrasound Diagnostics, Yaroslavl Railway Clinic, Yaroslavl/RU Purpose: To assess the performance of US service of the mobile railway clinic ‘‘Nikolay Pirogov’’. Material & Methods: Far North of Russia is known for extremely harsh climate, long distances between Hospitals with transportation difficulties, lack of modern equipment and qualified specialists. The mobile clinic of JSC ‘‘Russian railways’’ was launched in 2005 to improve the situation. It includes the units of surgery, general therapy, gynecology, clinical laboratory, radiology, ultrasound, functional diagnostics, and telemedicine centre located in six train carriages. Its ultrasound department is equipped with portable US scanners ‘‘Esaote Picus’’ and satellite telemedicine complex ‘‘Tandberg Tactical’’.