A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression
Introduction: Obstructive shock results from reduced cardiac output due to physical blockage of blood flow, such as cardiac tamponade. Cardiac tamponade compresses cardiac chambers, particularly the left atrium, causing decreased end-diastolic volume and cardiac output. Rapid fluid accumulation with...
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eScholarship Publishing, University of California
2024-12-01
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| Series: | Clinical Practice and Cases in Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/9jq4r5n2 |
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| author | Sharmin Kalam Sergio Marquez Emmelyn J. Samones Tammy Phan Vi Am Dinh |
| author_facet | Sharmin Kalam Sergio Marquez Emmelyn J. Samones Tammy Phan Vi Am Dinh |
| author_sort | Sharmin Kalam |
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| description | Introduction: Obstructive shock results from reduced cardiac output due to physical blockage of blood flow, such as cardiac tamponade. Cardiac tamponade compresses cardiac chambers, particularly the left atrium, causing decreased end-diastolic volume and cardiac output. Rapid fluid accumulation within the pericardial sac is the usual cause. Transesophageal echocardiography provides clearer visualization of these structures than transthoracic ultrasound. This case underlines the impact of esophageal pathology on cardiac output and highlights ultrasound’s dynamic diagnostic utility alongside computed tomography. Case Report: A 64-year-old female with a history of colon cancer and peritoneal metastases status post colostomy presented with altered mental status and urinary symptoms. Laboratory evaluation was notable for leukopenia, hypoglycemia, elevated ammonia, and an abnormal urinalysis that was positive for urinary tract infection. She was initially admitted to the internal medicine service for sepsis secondary to urine as the source of infection. During her hospital stay, she developed hypotension, tachypnea, tachycardia, and complained of chest pressure. Point-of-care echocardiogram revealed compression of the left atrium by distended gastric and esophageal contents. A nasogastric tube was placed and suctioned partially digested food and liquid with improvement of her condition. Follow-up ultrasound showed improvement of compression and cardiac function. Conclusion: In evaluation of acute shock, multiple etiologies must be considered. In this case, the cause of reduced cardiac output was direct compression of the left atrium from an adjacent structure. Even with direct visualization and imaging, immediate history and patient-centered approach are still useful to complete the clinical picture and treat the reversible cause of undifferentiated shock. |
| format | Article |
| id | doaj-art-76cda78360a64380bb288b0d52dd9216 |
| institution | Kabale University |
| issn | 2474-252X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Clinical Practice and Cases in Emergency Medicine |
| spelling | doaj-art-76cda78360a64380bb288b0d52dd92162025-02-04T17:35:19ZengeScholarship Publishing, University of CaliforniaClinical Practice and Cases in Emergency Medicine2474-252X2024-12-0191495210.5811/cpcem.21220cpcem-9-49A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial CompressionSharmin Kalam0Sergio Marquez1Emmelyn J. Samones2Tammy Phan3Vi Am Dinh4Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, CaliforniaLoma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, CaliforniaLoma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, CaliforniaLoma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, CaliforniaLoma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, CaliforniaIntroduction: Obstructive shock results from reduced cardiac output due to physical blockage of blood flow, such as cardiac tamponade. Cardiac tamponade compresses cardiac chambers, particularly the left atrium, causing decreased end-diastolic volume and cardiac output. Rapid fluid accumulation within the pericardial sac is the usual cause. Transesophageal echocardiography provides clearer visualization of these structures than transthoracic ultrasound. This case underlines the impact of esophageal pathology on cardiac output and highlights ultrasound’s dynamic diagnostic utility alongside computed tomography. Case Report: A 64-year-old female with a history of colon cancer and peritoneal metastases status post colostomy presented with altered mental status and urinary symptoms. Laboratory evaluation was notable for leukopenia, hypoglycemia, elevated ammonia, and an abnormal urinalysis that was positive for urinary tract infection. She was initially admitted to the internal medicine service for sepsis secondary to urine as the source of infection. During her hospital stay, she developed hypotension, tachypnea, tachycardia, and complained of chest pressure. Point-of-care echocardiogram revealed compression of the left atrium by distended gastric and esophageal contents. A nasogastric tube was placed and suctioned partially digested food and liquid with improvement of her condition. Follow-up ultrasound showed improvement of compression and cardiac function. Conclusion: In evaluation of acute shock, multiple etiologies must be considered. In this case, the cause of reduced cardiac output was direct compression of the left atrium from an adjacent structure. Even with direct visualization and imaging, immediate history and patient-centered approach are still useful to complete the clinical picture and treat the reversible cause of undifferentiated shock.https://escholarship.org/uc/item/9jq4r5n2 |
| spellingShingle | Sharmin Kalam Sergio Marquez Emmelyn J. Samones Tammy Phan Vi Am Dinh A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression Clinical Practice and Cases in Emergency Medicine |
| title | A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression |
| title_full | A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression |
| title_fullStr | A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression |
| title_full_unstemmed | A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression |
| title_short | A Case Report of Obstructive Shock from an Esophageal Bolus Leading to Left Atrial Compression |
| title_sort | case report of obstructive shock from an esophageal bolus leading to left atrial compression |
| url | https://escholarship.org/uc/item/9jq4r5n2 |
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