PMC9747626_01
Portable AP chest x-ray demonstrated concern for cardiomegaly and cephalization of pulmonary vasculature with no clear pulmonary edema.
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Portable AP chest x-ray was concerning for enlarged cardiac silhouette and cephalization of pulmonary vasculature with no pleural effusion or interstitial opacities (Fig. 1).
Lung ultrasound demonstrated vertical hyperechoic reverberation artifacts originating from the pleural line and extending to the periphery, known as B-lines. The presence of multiple B-lines indicated alveolar-interstitial syndrome.
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On arrival to the inpatient medicine service, lung ultrasound demonstrated multiple diffuse bilateral B-lines (Fig. 2), indicating alveolar-interstitial syndrome.
Cardiac ultrasound from parasternal long axis view demonstrated diminished endocardial excursion with poor movement toward the center of the left ventricle chamber during systole, as well as diminished mitral valve excursion with increased distance between the anterior leaflet of the mitral valve and interventricular septum. Both findings indicated reduced left ventricular systolic function.
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Cardiac POCUS revealed severely reduced left ventricular ejection fraction (LVEF) using qualitative assessment of endocardial excursion and septal motion of the anterior mitral valve leaflet (Fig. 3) and LVEF 19% using quantitative assessment of E-point septal separation (EPSS) (Fig. 4).