Opportunistic screening of extracardiac disorders during a standard transthoracic echocardiography

Transthoracic echocardiography (TTE) is a frequently requested investigation in patients admitted to hospital with various cardiorespiratory symptoms. With increasing life expectancy, these symptoms might be related to other clinical conditions, necessitating early and prompt diagnosis and subsequent management. We thought to broaden the use of the standard TTE to unmask clinically significant extracardiac findings (ECF). We screened the epigastrium, right upper abdominal quadrant, both flanks, and dorsal lung fields in 6468 consecutive inpatients undergoing TTE looking for aortic dilatation, liver pathology, ascites, pleural effusion and suspicious masses. We detected ECFs in 507 (8%) patients. Pleural effusion was the most commonly detected ECF seen in 86% of patients. ECF findings necessitating shift in the management plan were detected in 23% of patients and included large effusions necessitating drainage, malignant tumors (predominately liver metastases) and empyema. We concluded that routine screening of the liver, pleura, peritoneum and abdominal aorta could add an important piece of clinical information, detect pleural effusion, possible malignancies (mainly liver metastases) and aortic dilatation necessitating further assessment and management of hospitalized patients with various cardiopulmonary symptoms.