Misplacement of a Pulmonary Artery Catheter

We present the case of an attempted PAC insertion in a patient undergoing implantation of a left ventricular assist device. Although physiologic pressure waveforms were established, plausible measurements of cardiac output and pulmonary capillary wedge pressure were not initially obtainable. Chest radiography showed that the catheter was looped in the pulmonary artery. This malposition could not be visualized intraoperatively by transesophageal echocardiography. The PAC was replaced in the operating room after the left ventricular assist device was implanted.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

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Abstract Pulmonary hypertension (PH) is an end result of a diverse array of complex clinical conditions, which invoke hemodynamic and pathophysiological changes in the pulmonary vasculature. Many patients' symptoms begin with dyspnea on exertion for which screening tests like chest roentgenograms and more definitive non-invasive tests like CT scans are ordered initially. It is imperative that clinicians are cognizant of subtle clues on these imaging modalities that alert them to the possibility of PH. These clues may serve as a stepping stone towards more advanced non-invasive (ECHO) and invasive (right heart cath...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
By SAURABH JHA Sequels generally disappoint. Jason couldn’t match the fear he generated in the original Friday the 13th. The sequel to the Parachute, a satirical piece canvassing PubMed for randomized controlled trials (RCTs) comparing parachutes to placebo, matched its brilliance, and even exceeded it, though the margin can’t be confirmed with statistical significance. The Parachute, published in BMJ’s Christmas edition, will go down in history with Jonathan Swift’s Modest Proposal and Frederic Bastiat’s Candlemakers’ Petition as timeless satire in which pedagogy punched above, indeed d...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: OP-ED RogueRad Source Type: blogs
Proximal interruption of the pulmonary artery (PIPA) is an uncommon developmental anomaly resulting in underdevelopment of the proximal portion of the pulmonary artery with preservation of the intrapulmonary segments. Clinical presentation ranges between an asymptomatic incidental finding to massive hemoptysis. When findings suggestive of PIPA are present radiographically, the diagnosis of PIPA can be definitively diagnosed with computed tomography or magnetic resonance pulmonary angiography. Other imaging modalities, such as nuclear perfusion scan and catheter angiography can help in the diagnosis.
Source: Journal of Thoracic Imaging - Category: Radiology Tags: Review Articles Source Type: research
CONCLUSION: Percutaneous transvenous retrieval is a safe, minimally invasive and relatively simple procedure for the patients with fractured catheter and should be recommended as the first choice. PMID: 30320599 [PubMed - as supplied by publisher]
Source: Journal of X-Ray Science and Technology - Category: Radiology Tags: J Xray Sci Technol Source Type: research
CONCLUSION: Electrocardiography-guided central venous catheter tip positioning is a feasible real-time method for patients with atrial fibrillation. Combined with ultrasound, the electrocardiography-controlled central venous catheter placement may eliminate the need for postinterventional radiation exposure. PMID: 29512399 [PubMed - as supplied by publisher]
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
Publication date: Available online 5 September 2017 Source:Journal of Veterinary Cardiology Author(s): Chloe L. Thorn, Naomi R. Ford, Meg M. Sleeper A 2-year-old male intact Belgian Malinois was presented for exercise intolerance. A grade III/VI left basilar systolic murmur was detected. Echocardiography revealed moderate right atrial and ventricular dilation and increased pulmonic outflow velocity. Thoracic radiographs showed right heart enlargement and a dilated caudal vena cava. In addition, on the left lateral projection, an enlarged aberrant right cranial pulmonary lobar vein was suspected to be diverging ventrally f...
Source: Journal of Veterinary Cardiology - Category: Veterinary Research Source Type: research
Abstract CASE PRESENTATION: A 46-year-old man underwent redo bilateral sequential lung transplantation for rapidly progressive bronchiolitis obliterans syndrome that developed 3.5 years after initial transplantation. In the operating room, he was sedated and intubated with a dual lumen endotracheal tube with subsequent single right-lung ventilation and left allograft implantation. His pulmonary arterial pressure became elevated with reperfusion of the newly implanted left lung, which required initiation of cardiopulmonary bypass to facilitate implantation of the right lung. After implantation and reperfusion of th...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
A 54-year-old African American man presented with shortness of breath of two days duration. Physical examination revealed tachycardia with a heart rate of 113 bpm, oxygen saturation at 63% on room air and left sided crackles. Chest radiograph (Figure 1A) showed increased lucency of the right upper and middle lobes (Westermark ’s sign, blue arrow), enlarged right descending pulmonary artery (Palla’s sign, red arrow) and left lower zone pulmonary edema (black arrow). Computed tomography (CT) of chest (Figure 1B) with pulmonary angiogram confirmed extensive saddle pulmonary embolism (PE) at the right side with ext...
Source: QJM - Category: Internal Medicine Source Type: research
Clinical presentation A 35-year-old woman presented with rapidly progressive dyspnoea (WHO functional class III) two months after normal vaginal delivery at term, with no other symptoms. On examination, she was normotensive, with a raised jugular venous pressure, right ventricular (RV) heave, a prominent pulmonary second heart sound and mild pitting leg oedema. Oxygen saturations were 90% on air with a clear chest on auscultation. There was a single enlarged supraclavicular lymph node. ECG showed sinus tachycardia with right axis deviation. Renal and liver function were normal but brain natriuretic peptide and D-dimer were...
Source: Thorax - Category: Respiratory Medicine Authors: Tags: Emergency medicine, Chemotherapy, Screening (oncology), Venous thromboembolism, Pulmonary embolism, Pulmonary hypertension, Radiology (diagnostics) Chest clinic Source Type: research
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 61-year-old woman is evaluated for a 4-month history of progressive dyspnea and fatigue without chest pain. Eighteen months ago, she was diagnosed with liver cirrhosis due to nonalcoholic steatohepatitis (NASH). Medical history is also significant for obesity. Medications are propranolol, spironolactone, and lactulose. On physical examination, temperature is 36.4 °C (97.5 °F), blood pressure is 112/64 mm Hg, pulse rate is 60/min, and respiration rate is 16/min; BMI is 36. Mild scleral icterus i...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Uncategorized Source Type: blogs
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