VExUS scan in cardiorenal syndrome
Dr Himanshu Gul Mirani, Consultant in Emergency Medicine, Midland Metropolitan University Hospital, UK
Case Presentation:
84-year-old female, with limited mobility and history of atrial fibrillation (AF), moderate systolic dysfunction, HTN and CKD presented to ED with hypotension, AF with fast ventricular response (HR up-to 140/min) and new oxygen requirement. Her GCS was 15/15. She had bibasal crackles and dependent edema. Labs identified her to be in acute on chronic renal failure (AKI 2).
CXR showing fluid overload and pleural effusion and POCUS images suggestive of venous congestion
Management and Outcome:
X-ray showed upward diversion of vasculature and left sided pleural effusion.
POCUS confirmed bilateral pleural effusion, identified distended IVC with no respiratory changes and a congested liver. Hepatic vein doppler showed S wave reversal and portal vein showed increased pulsatility.
Patient was managed with diuretics despite being hypotensive and her BP improved with time. AF was managed with digoxin.
Key Learnings and Points:
Key Learning Points:
Along with B line score, VExUS is another tool in the armamentarium of ED physicians to objectively identify fluid overloaded patients and make appropriate treatment decisions.
In this case objective data points of venous excess scan (VExUS), suggestive of congestion of solid organ (VExUS grade 3) helped to manage this patient with diuretics despite being hypotensive. Over time her BP improved from systolic in 70s to high 90s & early 100s. It remained so for the duration of her hospital stay.