75yo man presented with urosepsis. After appropriate antibiotics & initial fluid resuscitation he was needing vasopressors. He had a failed insertion of R IJ CVC. Subsequently a femoral line was successfully inserted & vasopressors were started. He stabilised quickly on low dose noradrenaline.
A few hours later he became more tachycardic w dramatically increasing noradrenaline requirements. What investigation would you perform, & why?
First CXR shows some R apical capping – a sign of haemothorax. The next investigation would be to repeat the CXR.
The attempted R IJ approach was very low in this case, & caused a vascular injury resulting in a massive haemothorax. Note the associated tension pushing the mediastinum to the left side.