Critical Care
The Southwest Journal of Pulmonary and Critical Care publishes articles directed to those who treat patients in the ICU, CCU and SICU including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
Ultrasound for Critical Care Physicians: An Unexpected Target Lesion
Jantsen Smith, MD
Department of Internal Medicine
University of New Mexico Hospital
Albuquerque, NM USA
A 39-year-old woman was admitted to the hospital for shortness of breath. Her medical history was significant for human immunodeficiency virus infection (not on anti-retroviral therapy), superior vena cava (SVC) syndrome with history of SVC stenting, cerebrovascular accident complicated by seizure disorder and swallowing difficulties, moderate pulmonary hypertension, end-stage renal disease on hemodialysis with past episodes of acute hypoxic respiratory failure related to fluid overload. Shortly after admission, the patient experienced a cardiac arrest due to hypoxia and necessitated emergent intubation. This was presumed to be due to fluid overload. Nephrology was consulted for emergent dialysis (the patient had a right upper extremity fistula for dialysis access). Dialysis was initiated through a right arm fistula. On day three of admission, the patient was noted to have worsening right upper extremity and breast swelling and pain. Physical exam revealed indurated edema of the skin of the breast. Point of care ultrasound was performed of the patient’s right neck, and the following ultrasound was obtained approximately 4cm above the clavicle in the right lateral neck.
Video 1. Ultrasound image of the right neck in the transverse plane.
What is the most likely cause of this patient’s right upper extremity and breast swelling? (Click on the correct answer for an explanation).
- Right breast cellulitis
- Ascending SVC thrombus
- Lymphatic blockage of right axillary nodes
- Fluid overload complicated by third spacing in the R upper extremity
Cite as: Smith J. Ultrasound for critical care physicians: An unexpected target lesion. Southwest J Pulm Crit Care. 2019;18(3):63-4. doi: https://doi.org/10.13175/swjpcc011-19 PDF
Ultrasound for Critical Care Physicians: Now My Heart Is Still Somewhat Full
Krystal Chan, MD
Bilal Jalil, MD
Department of Internal Medicine
University of New Mexico School of Medicine
Albuquerque, NM USA
A 48-year-old man with a history of hypertension, intravenous drug abuse, hepatitis C, and cirrhosis presented with 1 day of melena and hematemesis. While in the Emergency Department, the patient was witnessed to have approximately 700 mL of hematemesis with tachycardia and hypotension. The patient was admitted to the Medical Intensive Care Unit for hypotension secondary to acute blood loss. He was found to have a decreased hemoglobin, elevated international normalized ratio (INR), and sinus tachycardia. A bedside echocardiogram was performed.
Figure 1. Apical four chamber view of the heart.
Figure 2. Longitudinal view of the inferior vena cava entering into the right atrium.
What is the best explanation for the echocardiographic findings shown above? (Click on the correct answer for an explanation and discussion)
Cite as: Chan K, Jalil B. Ultrasound for critical care physicians: now my heart is still somewhat full. Southwest J Pulm Crit Care. 2016;12(6):236-9. doi: http://dx.doi.org/10.13175/swjpcc054-16 PDF