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Radiology Case 3

Home Radiology Case 3

ICU rad_pic 

By Dimity McCracken

These are images from real ICU patients.

[su_tabs][su_tab title=”History”]

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?

[/su_tab][su_tab title=”Image”]

rad3a
[/su_tab][su_tab title=”Answer”]

 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.

rad3b

Patient subsequently required intubation, insertion of 2 chest drains, & blood product resuscitation.

This did not control the bleeding, so patient went to theatres for an emergency vascular repair.

rad3c

[/su_tab][su_tab title=”Learning Point”]

 For every procedure you perform:

-know the anatomy

-know the potential complications

-recognise a complication early – don’t be proud! Everyone has complications at some time or other!

[/su_tab]
[/su_tabs] 

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