Last but not least

Image in interventional cardiovascular medicine: what is displayed on this image? ... And do not hesitate to comment on how you would treat this case!

A 72-year-old woman underwent pacemaker extraction due to sheath infection. The procedure was complicated by rupture of the right ventricle, which was resolved surgically. Post-operatively, she presented with hypotension, abdominal pain and a decreased unilateral vesicular murmur, the most likely differential diagnosis being pneumothorax. Cardiac ultrasound showed no sign of tamponade, and lab results showed no sign of bleeding. Chest x-ray showed pneumothorax which was treated by draining without improvement of hypotension, even with vasopressor agents. As severe hypotension persisted with good level of consciousness, blood pressure was tested in both legs and found to be normal at 120 mmHg. Vascular ultrasound and computed tomography angiogram were scheduled.An image is worth a 1,000 words: participate in the quiz below to tell us what you see in this image!

Authors

TYROVOLA Dimitra¹, DIMITRIADIS Kyriakos², ARCHONTAKIS Stefanos¹, BENEKI Eirini¹, SIDERIS Skevos¹

1. Cardiology Department, Hippokration Hospital, Athens, Athens, GREECE
2. First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece, Athens, GREECE