Syncope and Hypotension

Q: What does this research mean for the field?

Subcostal echocardiographic imaging can detect a mobile right heart thrombus traversing the tricuspid valve with right ventricular dilation in patients presenting with syncope and hypotension from acute pulmonary embolism. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Joseph Randazzo; Jeffrey Gardecki; Sandra Guirguis; Megan Stobart‐Gallagher

doi:10.1016/j.acepjo.2026.100483

August 4, 2026Journal of the American College of Emergency Physicians OpenOpen Access

Syncope and Hypotension

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Key result

Subcostal echocardiography identifies mobile right heart thrombus and RV dilation causing syncope and shock.

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Key Points

Identify the underlying cardiovascular etiology in a presentation of syncope and hypotension using bedside ultrasound imaging.
Subcostal echocardiographic imaging was utilized to visualize cardiac chambers and evaluate hemodynamic collapse.
Imaging revealed a dilated right ventricle with a mobile thrombus directly traversing the tricuspid valve.
The visualized right ventricular dilation confirmed acute right heart strain secondary to acute pulmonary embolism.

Structured PICO

P

Population

A 95-year-old woman with a past medical history of hypertension presenting with syncope and hypotension (n=1)

I

Intervention

Focused echocardiogram (Rapid Ultrasound for Shock and Hypotension exam) and CT pulmonary angiography

O

Outcome

Identification of clot-in-transit and right ventricular dilation indicating acute pulmonary embolism

Direct visualization of a right heart thrombus on focused echocardiography allows for rapid diagnosis of clot-in-transit and pulmonary embolism in hemodynamically unstable patients.

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Implication

May enable immediate bedside identification of right heart thrombus in unstable syncope; Level 5 evidence leaves open prospective validation.

Abstract

FIGURE.Subcostal image demonstrated dilated right ventricle with thrombus traversing tricuspid valve, arrow.VIDEO.Mobile right heart thrombus with right ventricle dilation suggestive of right heart strain from acute pulmonary embolism.

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Cite This Study

Randazzo et al. (2026) studied this question. Subcostal imaging revealed a mobile right heart thrombus traversing the tricuspid valve and right ventricular dilation, suggesting acute pulmonary embolism causing syncope and hypotension.

synapsesocial.com/papers/6ad0fc6015427f6a84040043 https://doi.org/10.1016/j.acepjo.2026.100483

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Syncope and Hypotension

Figures

Key Points

Structured PICO

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Implication

Abstract

Discussion

Cite This Study

Syncope and Hypotension

Figures

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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