By Rob Leeper, MD, FRCSC

The Critical Care Outreach Team is called to asses a 64 year old male on the thoracic surgery floor complaining of increasing shortness of breath and hypotension. He is status post left upper lobectomy for non small cell lung cancer 1 year ago.  He has been re-admitted for workup of a possible recurrence in his mediastinal nodes.

In the 24 hours prior to CCOT arrival he had become progressively acidotic and hypotensive.  This was presumed to be on the basis of sepsis and appropriate treatments had been instituted.  Despite this the patient remained hypotensive with BP sitting 90’s/50’s.  His gases and clinical state worsened and he was taken to the ICU for further evaluation and monitoring.

As is routine for patients admitted to our ICU’s with circulatory failure, a point of care echocardiogram was performed on arrival to the ICU:

Subcostal 4 Chamber



Parasternal Short Axis



Apical 4 Chamber



What is your impression of the images?  Is there any significant abnormalities seen?  Click HERE for the answers and discussion and to learn the outcome of the case.