Utilization of cardiac point-of-care ultrasonography in evaluating a case of heart failure secondary to an intracardiac mass: A case report

Background: Intracardiac mass is a rare medical emergency and may present with signs of heart failure, like syncope. The current use of cardiac point-of-care ultrasound (POCUS) in pediatric emergency departments does not visualize pulmonic valve pathologies as a standard of care. Case presentation: We report a case of a previously well Arab male child who presented with a history of cardiac syncope, with other symptoms of heart failure. Using cardiac POCUS, we were able to identify sonographic signs of heart failure and also accidentally identify a mass in the right ventricle on the pulmonic valve after some manipulation of the probe during the 4-apical chambers view. Confirmation was followed using echocardiography, computed tomography angiography, and cardiac magnetic resonance imaging. The patient underwent medical treatment for his heart failure and then surgical removal and histopathological examination of the mass, which was found to be an organized hematoma. Conclusion: A cardiac POCUS has emerged as a readily available tool to evaluate global cardiac systolic function and both ventricular size for emergency physicians. Mitral valve closure is the main goal for using focused cardiac POCUS in the emergency department, but assessing other valves in terms of closure, appearance, and regurgitation can also be addressed. We suggest in our case some modifications to the 4-apical chambers view as an additional evaluation to visualize any pathologies to the pulmonic valve. These modifications may be used by pediatric emergency medicine physicians to enhance pulmonic valve assessment further when using POCUS in emergency settings.