scholarly journals Cardiac perforation due to delayed migration of a chronic dialysis catheter: A case report

2021 ◽  
Author(s):  
Charlotte Jahnke ◽  
Elion Hoxha ◽  
Gerold Söffker ◽  
Moritz Seiffert
Keyword(s):  
Cardiac Arrest ◽  
Contrast Echocardiography ◽  
Correct Diagnosis ◽  
Diagnostic Procedures ◽  
Pericardial Tamponade ◽  
Circulatory Shock ◽  
Right Atrial ◽  
Dialysis Session ◽  
Haemodialysis Catheter ◽  
Surgical Extraction

Abstract BACKGROUND Tunnelled haemodialysis catheters are commonly used to perform haemodialysis. Rare complications of these catheters include perforations of major blood vessels or the heart. Albeit rare, these complications can lead to significant morbidity and mortality. CASE SUMMARY We present a case of late migration of a tunnelled haemodialysis catheter causing a right atrial perforation with subsequent pericardial tamponade, haemodynamic shock, and cardiac arrest. A 51-year-old female patient with end-stage renal disease presented with hypotension and lactate acidosis, indicating circulatory shock, during ambulatory intermittent haemodialysis. Dialysis was performed through a tunnelled haemodialysis catheter that had been implanted more than 1 year ago. Upon admission to the hospital, initial diagnostics, including transthoracic echocardiography and computed tomography scan, showed a circumferential pericardial effusion which was not haemodynamically significant and no other pathological findings. After being transferred to the intensive care unit, the patient again showed signs of haemodynamic shock at the start of another dialysis session which deteriorated to cardiac arrest. Ultimately, using multi-modality imaging, migration of the catheter tip through the right atrial wall into the pericardial space was diagnosed. Emergency sternotomy and surgical extraction of the tunnelled haemodialysis catheter were performed and the patient recovered completely. DISCUSSION Migration and perforation of a tunnelled haemodialysis catheter can occur late after implantation and lead to circulatory shock, thus requiring immediate diagnostic workup and surgical therapy. Routine diagnostic procedures may be insufficient for making a correct diagnosis. More specific approaches, such as multi-modality imaging including contrast echocardiography, should be implemented upon clinical suspicion.

Comparative analysis of diagnostic procedures for tumor detection rates in paired data

2018 ◽  
Vol 28 (5) ◽  
pp. 1477-1488
Author(s):  
Yaeji Lim ◽  
Ji Soo Choi ◽  
Kiyoun Kim ◽  
Mira Park ◽  
Seonwoo Kim
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Correct Diagnosis ◽  
Disease Status ◽  
Diagnostic Procedures ◽  
Tumor Detection ◽  
Tumor Location ◽  
Test Statistic ◽  
Paired Data ◽  
Detection Rates

Diagnostic procedures are mostly used to detect a particular disease, and each procedure indicates the presence or absence of the disease in an individual. Sensitivity and positive predictive value, which are measures of the effectiveness of a diagnostic procedure, are simply calculated as the proportion of the individuals diagnosed with the disease by the test among the patients with the disease, and of the diseased persons among the individuals in whom the disease was detected by the test, respectively. For a diagnosis with such a binary result, sensitivity and the positive predictive value of diagnostic procedures can be compared using the chi-square statistic. However, in the treatment of cancer patients, it is important not only to diagnose the disease status of an individual patient but also to detect the correct location of the cancer. The tumor location may be incorrectly identified in some subjects diagnosed with cancer. It is therefore of interest whether a procedure that diagnoses cancer also correctly indicates the tumor location. In this paper, we re-define the sensitivity and the positive predictive value of tumor detection as the ratio of the number of cases with a correct diagnosis of the tumor location by the test to the number of cases of cancer, and as the ratio of patients with a correct diagnosis of the tumor location to the number of individuals diagnosed with cancer by the test, respectively. We refer to these parameters as ‘semi-sensitivity’ and ‘semi-positive predictive value’. To compare these ratios between diagnostic procedures, test statistics are developed from binary diagnostic results. Simulation studies conducted to evaluate the nominal level and power are presented, and two sets of example data are also analyzed using the new test statistic.

Measurement of mean circulatory filling pressure and vascular compliance in domestic pigs

1990 ◽  
Vol 258 (6) ◽  
pp. H1925-H1932 ◽  
Author(s):  
R. I. Ogilvie ◽  
D. Zborowska-Sluis ◽  
B. Tenaschuk
Keyword(s):  
Cardiac Arrest ◽  
Circulatory Arrest ◽  
Filling Pressure ◽  
Right Atrial ◽  
Base Line ◽  
Pentobarbital Sodium ◽  
Closed Chest ◽  
Mean Circulatory Filling Pressure ◽  
Vascular Compliance ◽  
Venous Circulation

To measure mean circulatory filling pressure (Pmcf), a balloon was placed in the right atrium of seven pentobarbital sodium-anesthetized open-chest pigs for transient occlusion of flow combined with mechanical transfer of blood from the arterial to the venous circulation. Equilibration occurred within 6-8 s at a pressure at 12.3 +/- 0.3 (SE) mmHg after a 2.9 +/- 0.2 ml/kg transfer of blood. In another group of pentobarbital sodium-anesthetized closed-chest pigs, acetylcholine (ACh) was used to induce cardiac arrest. The Pmcf was 11.6 +/- 1.0 mmHg in the 7:17 pigs that arrested for 6-8 s. In four isoflurane-anesthetized closed-chest pigs, the Pmcf was 12.0 +/- 1.0 mmHg after terminal cardiac arrest induced by KCl. The pressure gradient for venous return [Pmcf--right atrial pressure (Pra)] averaged 5.9 +/- 0.2 mmHg. Total vascular compliance estimated from plots of Pmcf at base line, 5, and 10 ml/kg increases in circulating volume was 2.1 +/- 0.3 and 3.5 +/- 0.9 ml.kg-1.mmHg-1 in the balloon and ACh groups, respectively compared with 2.8 +/- 0.4 ml.kg-1.mmHg-1 using a volume infusion-withdrawal method without circulatory arrest. The use of ACh for the estimate of Pmcf in the pig is not recommended because of failure to consistently induce circulatory arrest and probable failure to achieve sufficient equilibrium of vascular pressures 6-8 s postarrest when it occurs.

Ventricular fibrillation during uniform myocardial anoxia due to asphyxia

1960 ◽  
Vol 198 (5) ◽  
pp. 955-958 ◽  
Author(s):  
Jay D. Coffman ◽  
D. E. Gregg
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Potassium Level ◽  
Serum Potassium Level ◽  
Current Theory ◽  
The Other ◽  
Right Atrial ◽  
Serum Electrolytes ◽  
Anesthetized Dogs ◽  
A Current

Thirty-three anesthetized dogs of varying weights were subjected to complete asphyxia by tracheal occlusion to produce uniform anoxia of the heart. Eleven showed electrocardiographic evidence of ventricular fibrillation while the other twenty-two demonstrated cardiac arrest. The development of ventricular fibrillation correlated with the heavier body and heart weights and with a lower average right atrial serum potassium level as compared to the dogs not fibrillating. Other serum electrolytes, pH, body temperature and sex showed no correlation with the arrhythmia. The importance of the fact that large dogs have a greater susceptibility to develop ventricular fibrillation during uniform anoxia of the heart is discussed in relation to experimental research on dogs and to a current theory of the cause of ventricular fibrillation.

Contrast echocardiography in a patient with right atrial myxoma

2011 ◽  
Vol 7 (02) ◽  
pp. 115-117
Author(s):  
Masahito Moriuchi ◽  
Satoshi Saito ◽  
Tomohiko Kamata ◽  
Yoshiaki Takaiwa ◽  
Naoshi Tanigawa ◽  
...  
Keyword(s):  
Contrast Echocardiography ◽  
Atrial Myxoma ◽  
Right Atrial ◽  
Right Atrial Myxoma

Difficulties associated with the diagnosis of tuberculous osteomyelitis of the ribs in children

2021 ◽  
Vol 16 (2) ◽  
pp. 74-79
Author(s):  
M.D. Zvereva ◽  
◽  
S.S. Kanash ◽  
S.I. Petrova ◽  
V.A. Evseev ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Diagnostic Procedures ◽  
Diagnostic Methods ◽  
Mantoux Test ◽  
Comprehensive Treatment ◽  
Tuberculous Osteomyelitis ◽  
The Right ◽  
Tuberculosis In Children

Diagnosis of tuberculosis in children is challenging because of variable clinical symptoms and no specific signs. We report a case of tuberculous osteomyelitis of the ribs, which demonstrates difficulties associated with the diagnosis of generalized tuberculosis in an 8-year-old child (correct diagnosis was established after 1.3 years). Diagnostic procedures included: Mantoux test, skin test with recombinant tuberculosis allergen, computed tomography, pathomorphological and bacterioscopic testing. The patient presented with disease progression and lesions to the lung tissue, pleura, and ribs and did not respond to antibacterial therapy, hormones, and cytostatics. This required repeated diagnosis revision. The diagnosis of tuberculosis of the right 4th and 5th ribs was confirmed after surgery using bacterioscopic and immunohistochemical examinations. The child received comprehensive treatment in a specialized tuberculosis hospital and had positive dynamics. Despite the correct routing, low suspicion for tuberculosis in primary and secondary healthcare institutions has led to an insufficient use of currently available diagnostic methods and late diagnosis of tuberculosis in a child residing in a megapolis. Key words: generalized tuberculosis, children, tuberculosis of the rib, immunodiagnostics, diagnosis of tuberculosis, immunohistochemistry

Cardiovascular System

2015 ◽  
pp. 423-450
Author(s):  
Wolf Benjamin Kratzert ◽  
Eva Katherine Boyd
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Output ◽  
Cardiac Surgery ◽  
Pericardial Tamponade ◽  
Right Ventricular Failure ◽  
Orthotopic Heart Transplantation ◽  
Low Cardiac Output Syndrome ◽  
Future Directions ◽  
Low Cardiac Output ◽  
Hemodynamic State

This chapter addresses underlying physiology, diagnostics, and management of common cardiovascular abnormalities in the patient after cardiac surgery. The goal is to provide insights into daily management, areas of controversy, and future directions in the field. After reviewing basic physiologic principles of cardiac output and circulation; problems affecting the postoperative hemodynamic state will be addressed individually. Specific topics include the low cardiac output syndrome, right ventricular failure, myocardial ischemia, diastolic dysfunction, vasodilatory syndrome, rhythm disturbances, pericardial tamponade, and cardiac arrest. Patients with postoperative open chests, or after orthotopic heart transplantation are also discussed.

scholarly journals Haemodialysis catheter-related giant right atrial and superior cava thrombi

2015 ◽  
Vol 2015 (feb26 1) ◽  
pp. bcr2015209350-bcr2015209350 ◽  
Author(s):  
L. Weinberg ◽  
F. Zia ◽  
S. Tay ◽  
N. Roubos
Keyword(s):  
Right Atrial ◽  
Haemodialysis Catheter

scholarly journals Cardiac Tamponade in a Postpartum Woman with Lemierre's Syndrome

1998 ◽  
Vol 26 (5) ◽  
pp. 582-583 ◽  
Author(s):  
A. S. McLean ◽  
K. Tyler
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Tamponade ◽  
Anticoagulant Therapy ◽  
Pericardial Tamponade ◽  
Postpartum Woman ◽  
Lemierre’S Syndrome ◽  
Successful Resuscitation ◽  
Mediastinal Infection ◽  
Lemierre's Syndrome

A 23-year-old primigravida with Lemierre's syndrome developed pericardial tamponade secondary to mediastinal infection and anticoagulant therapy. Intrathoracic echocardiographic diagnosis during a period of cardiac arrest led to urgent pericardiocentesis and successful resuscitation.

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