Cuban Experience with Lung Ultrasound to Diagnose and Classify Pleural Effusion in Critically Ill Patients.

Pleural effusion is a common condition in critically ill patients (both clinical and surgical). Its diagnosis and classification are important for followup of patients with cardiorespiratory difficulty. Lung ultrasound is used for this purpose, but no reports have been published on its use in Cuba with critically ill patients in intensive care units. We performed lung ultrasound on 144 such patients with cardiorespiratory illnesses, average age 54 years, predominantly men (66%; 95/144), with average APACHE II score 13.6, and 22.1% mortality risk. Patients were divided into two groups: clinical (bronchopneumonia and cardiac insufficiency) and surgical (postoperative liver and kidney transplant or vascular and cardiovascular surgery) to diagnose and classify pleural effusion according to locus (right, left and bilateral) and structural pattern (I, II A, II B, III and IV). Pleural effusions were diagnosed in 81.2% (117/144) of patients (clinical 44.4%, 52/117; surgical 55.6%, 65/117). Bilateral location was the most common (68.4%, 80/117), followed by right (23.9%, 28/117) and then left (7.7%, 9/117). Structural pattern I (anechoic appearance) was observed in 61.5% of cases (72/117); 21.4% (25/117) were II A, 12.8% (15/117) II B, 3.4% (4/117) III, and 0.9% (1/117) were IV. We found no association between pleural effusion localization and ultrasound structural pattern in clinical patients (Fisher exact test 4.2 p = 0.9). In surgical patients, however, complex ultrasound patterns (II A, II B and III) were significantly more common in bilateral forms (Fisher exact test 14.1; p = 0.009). Further studies of this type in Cuba will help provide useful data for prompt treatment and followup of these patients.

Tromboembolismo pulmonar o infarto de ventrículo derecho: dilema clínico: a propósito de un caso / Pulmonary embolism or right ventricular infarction: clinical dilemma: apropos of a case

El tromboembolismo pulmonar es una emergencia cardiovascular que a menudo es difícil de diagnosticar. Se presenta el caso de un hombre de 44 años que, posterior a una intervención quirúrgica abdominal, presentó un cuadro de inestabilidad hemodinámica interpretado como tromboembolismo pulmonar, pero el hallazgo de supra-desnivel del ST en precordiales derechas determinó la sospecha clínica de un infarto de miocardio de ventrículo derecho. La ausencia de lesiones coronarias en el estudiocoronariográfico invasivo y la presencia de evidencias de sobrecarga de presión en el ventrículo derecho, así como de trombosis de miembros inferiores, corroboraron el diagnóstico inicial. Este caso enfatiza que esta enfermedad debe ser sospechada en todo paciente con clínica sugestiva, incluso en presencia de hallazgos electrocardio-gráficos sugestivos de infarto de miocardio, sobre todo en ausencia de compromiso de la circulación coronaria y de evidencia ecocardiográfica de disfunción del ventrículo derecho asociado a signos de hipertensión pulmonar(AU)