Images in Thorax
Pulmonary infarction from central venous air embolism mimicking round pneumonia
1 Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
2 Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Correspondence to:
Correspondence to:
Dr Lung-Chun Lin
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, No 7 Chung-Shan South Road, Taipei 100, Taiwan; anniejou@ms28.hinet.net
| The first 150 words of the full text of this article appear below. |
A 49-year-old man was diagnosed with dilated cardiomyopathy after presenting with congestive heart failure since 1995. He experienced a flare-up of symptoms after an upper respiratory tract infection 1 week before admission to the coronary care unit (CCU). His dyspnoea improved after treatment with diuretics and inotropes. On day 4 in the CCU he developed a urinary tract infection complicated by septic shock. A central venous catheter (CVC) was inserted over the right internal jugular vein. There was difficulty in performing the catheterisation, and the procedure was prolonged due to an extremely low intravascular volume. Soon after the procedure a round opacity was noted on the chest radiograph (fig 1
). At that time there was no purulent sputum, airway symptoms or physical examination compatible with pneumonia. A chest CT scan revealed air emboli in the superior vena cava (arrow, fig 2A) and wedge-shaped pulmonary infarcts with central necrosis
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