A 85 y/o woman with abdominal pain

 

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation : Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : rahebe jafarinia

 

Case Section

Abdominal Imaging

 

Patient's Information

Gender : Female
Age : 85

 

Clinical Summary

A 85 y/o woman with abdominal pain,nausea,vomiting with cholecystectomy 10 years ago.after IVcontrast abdominal CT scan she has lost consciousness and intubated.in ECG after intubation,ST elevation in precordial leads was seen.

 

Imaging Findings

LVH is present.reflux of contrast is seen in IVC,hepatic veins,right renal vein.heterogenous nephrogram is seen in left renal parenchymal and wedge shape hypodens area is seen in spleen.

 

Differential Diagnosis

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Final Diagnosis

Impending to cardiogenic shock

 

Discussion (Related Text)

Although only rarely reported, the imaging findings of sudden cardiac arrest are quite characteristic. There is little opacification of the left heart chambers and the aorta, the contrast settling down in the dependent portions of the right side of the body, predominantly in the venous system. The radiologist should be aware of the imaging findings so that proper resuscitative measures can be taken immediately in such cases, instead of continuing with the imaging. Dependent layering of contrast and the formation of a contrast-blood level carry a grave prognosis for the patient. The treating physician should be informed immediately as these findings imply imminent cardiogenic shock. Dependent contrast pooling and layering were found in all of them, with faint or no opacification of the left cardiac chambers. Contrast pooling was noted in the dependent lumbar veins, hepatic veins, hepatic parenchyma, and the right renal vein, as well as in the dependent part of the IVC and the right heart chambers.

 

References

J Comput Assist Tomogr. 2012 May-Jun;36(3):291-4. doi: 10.1097/RCT.0b013e318250a8bc.

 

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