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Radiology
Case #1 - A 78-year-old white man with nausea, vomiting
and dehydration
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Ehab Kodsi, MD, PhD
A
78-year-old white man presented to the emergency room with
a four-day history of nausea, vomiting and dehydration.
He was hydrated but continued to complain of nausea and
vomiting. One day after admission, he became acutely dyspneic
with increased lung secretions. An increase in the heart
rate to the 120s was noted followed by oxygen desaturation
and ventilatory insufficiency which led to the intubation
and transfer of the patient to the intensive care unit.
A nasogastric tube was placed with return of three liters
of dark brown fluid. The patient remained hypotensive despite
aggressive volume resuscitation with normal saline. A right
subclavian triple lumen catheter was placed. The patient
then again became hypoxic despite being on 100% oxygen and
his blood pressure dropped to 60s/30s. The X-Ray shown below
was obtained at this moment.
Can
you explain what has happened from the X-Ray?
See
larger view
See
answer
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