September 2016 critical care case of the month

Abstract

No abstract available. Article truncated after the first page. Clinical History: A 66-year-old man was admitted to the ICU in complete heart block with borderline hypotension. After cardiology consultation, a decision was made to place an urgent transvenous pacer. The transvenous pacer was place without use fluoroscopy from an right internal jugular venous (IJV) approach using real time ultrasound by two very experienced operators. The ultrasound confirmed right IJV placement and the pacer was found to capture and pace appropriately without any complications. A post placement CXR was obtained (Figure 1). What does the chest x-ray show? 1. A persistent left SVC; 2. Normal placement of the RIJV TVP. 3. Right pneumothorax; 4. TVP pacer passing from RIJV and then into the aorta and left ventricle. 5. TVP pacer passing outside heart and pacing epicardially. ...

Keywords

• persistent left superior vena cava
• congenital
• right internal jugular vein
• coronary sinus
• pacemaker insertion
• chest x-ray
• CT scan
• asymptomatic
• congenital abnormality
• anomalous venous drainage