Cardiomyopathy and pulmonary emboli in terminal Duchenne's muscular dystrophy

Abstract

should raise the possibi l i ty of a t raumat ic fistula. 1 This case was unusual in tha t prolonged survival such as this is uncommon and probably occurred because of local tamponade and occlusion of the wound by extensive thrombus. Per iphera l emboli are also an uncommon event and should alert the physician to the possibil i ty of a bul let embolus. 4 The repeated emboli in this pa t ien t reflect the friable nature of the aortic thrombus and the extensive damage tha t bul let wounds may cause to the vessel wall. 5 Angiography has been the t rad i t ional method of evaluating pathologic condit ions of the aorta, but because of the hemodynamic instabi l i ty associated with penetra t ing wounds of the aorta, it may not be safe and may cause undue delay in management of the patient . T E E is a safe bedside technique tha t has been shown to be as reliable as angiography in the evaluat ion of thoracic aortic dissections and aneurysms and superior to computed tomography scanning, s This case highlights the usefulness of TEE and also shows the advantages of recently developed biplane imaging. Longaxis scanning provided a much greater appreciat ion of the three-dimensional nature of the aortic clot and allowed the use of color flow mapping and Doppler quantif icat ion of the obstruction. T E E may reduce the need for extensive angiography and hence permi t more rapid definitive t reatment.