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IMAGINGININTENSIVECAREMEDICINEQuickdiagnosisofvenousairembolismShakeerShaik,JyotiBuradandMohamedAl‐IsmailiIntensiveCareMedDOI10./s---5A38-year-oldmanwithidiopathicdilatedcardiomyopathyandchronicatrialbrillationpresentedwithsymptomsofheartfailure.Heunderwenttemporaryoverridepacemakerinsertionthroughrightfemoralaccess.Afewhourslater,hedevelopedshock.Centralvenous(femoral)andarterial(radial)cannulationswereperformedfororgansupportandmonitoring.Inspiteofcardiorespiratorysupport,hislactatelevelincreasedsteadily.ACTscanwasdonetoruleoutmesentericischemia.Bedsideechocardiographywasperformedtoidentifythetypeofshock.Itshowedgrossairintheinferiorvenacavaandrightventricleaswellasadilatedrightventriclewithflattenedinterventricularseptumandlowejectionfraction(Video1;Fig.1).Managementofairembolismwasinitiatedwith%oxygen,steephead-downwithleftlateraldecubituspositioning,andaspirationofairthroughanewlyinsertedrightatrialcatheter.Thepatientdevelopedacutekidneyinjuryforwhichrenalreplacementtherapywasinstituted.CTscanconfirmedpresenceofairintheinferiorvenacava(IVC),femoralandhepaticveins(Fig.1).Follow-upechocardiographyshowedresolutionofair.
一名38岁男性患者罹患特发性扩张性心肌病及慢性房颤，患者因心衰就诊。经右侧股静脉植入临时起搏器。数小时后，患者出现休克。留置中心静脉（股静脉）及动脉（桡动脉）用于器官功能支持及监测。尽管进行了呼吸循环功能支持，但患者乳酸仍持续升高。进行CT扫描以排除肠系膜缺血。床旁心脏超声检查确定休克类型。影像学检查发现下腔静脉及右心室有大量气体，同时发现右心室扩大伴室间隔变平，射血分数较低（图1）。遂采取措施治疗气体栓塞，包括吸入纯氧，采取头低的右侧卧位，并通过新置入的右房导管抽吸气体。患者随后出现急性肾损伤并接受肾脏替代治疗。CT扫描确诊下腔静脉(IVC)、股静脉及肝静脉内气体（图1）。心脏超声随访显示气体消失。
Severeairembolismisaserious北京治疗白癜风哪里比较好北京白癜风专科医院电话
