Spontaneous Coronary Sinus Thrombosis Detected by Point-of-care Transthoracic Echo: A Case Report
Lily Leitner Berrin1, Kaitlen Howell1, Amanda Foote2
1Highland Hospital, Alameda Health System, Department of Emergency Medicine, Oakland, California.
Insights
Coronary sinus thrombosis (CST) is a rare condition. Point-of-care ultrasound diagnosed CST in a healthy patient presenting with chest pain after cocaine use, a novel finding in emergency medicine.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Ultrasound
Background:
- Coronary sinus thrombosis (CST) is a rare condition, often linked to cardiac procedures.
- CST typically presents with severe illness and has a high mortality rate (80%).
- No prior cases of spontaneous CST diagnosed by point-of-care ultrasound have been reported.
Purpose of the Study:
- To report a unique case of coronary sinus thrombosis diagnosed via point-of-care ultrasound.
- To highlight the potential of point-of-care ultrasound in diagnosing rare cardiac conditions.
Main Methods:
- Case report of a 38-year-old male with chest pain after cocaine use.
- Electrocardiogram showed Wellens syndrome pattern.
- Point-of-care cardiac ultrasound identified coronary sinus thrombosis.
Main Results:
- Diagnosis of coronary sinus thrombosis (CST) in a previously healthy individual.
- Identification of CST using point-of-care ultrasound in the emergency setting.
- The patient presented with symptoms suggestive of acute coronary syndrome.
Conclusions:
- Coronary sinus thrombosis can be diagnosed using clinician-performed point-of-care ultrasound.
- This represents the first reported case of spontaneous CST diagnosed via point-of-care ultrasound in emergency medicine literature.
- Clinician sonographers can recognize this uncommon finding during standard echocardiograms.
Introduction:
Coronary sinus thrombosis (CST) is a rare condition, primarily occurring after instrumentation of the heart, with no prior reported cases diagnosed via point-of-care ultrasound or of spontaneous occurrence without predisposing medical or surgical history. Patients typically present with critical illness, and CST has a reported mortality of 80%.
Case Report:
We present a case of a healthy 38-year-old male with chest pain one hour after cocaine use, with an electrocardiogram pattern consistent with Wellens syndrome, whose point-of-care cardiac ultrasound revealed CST.
Conclusion:
This uncommon ultrasonographic finding has never been reported in the emergency medicine literature to our knowledge. It can be recognized by the clinician sonographer during standard point-of-care transthoracic echocardiogram.
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