Whole lung pulmonary angiography in the intensive care unit with two portable chest x-rays.
Suspected massive pulmonary embolism requires urgent, accurate diagnosis. We describe a technique for pulmonary angiography in the ICU. Four patients admitted with suspected pulmonary embolism had fulminating cardiorespiratory failure with support requirements precluding transfer. Each patient had a flow-directed pulmonary angiography catheter inserted into the pulmonary artery. In two catheter positions, 25 ml of iopamidol 612 mg/ml was delivered from a portable angiographic injector at a flow of 20 ml/sec. A portable x-ray was taken immediately before completion of syringe excursion. Major central pulmonary emboli were seen in three patients and a negative angiogram was obtained on the fourth. Two of the three positive diagnoses were confirmed at pulmonary embolectomy. The negative diagnosis was confirmed at autopsy. Pulmonary angiography via a flow-directed catheter enabled precise and rapid diagnosis of pulmonary embolism in patients too ill to transfer for formal angiography.
Rosengarten
P L
PL
Intensive Care Unit, Alfred Hospital, Victoria, Australia.
Tuxen
D V
DV
Weeks
A M
AM
D000328:Adult; D000368:Aged; D000792:Angiography / Q000295:instrumentation / Q000379:methods*; D002405:Catheterization, Central Venous / Q000295:instrumentation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D011669:Pulmonary Wedge Pressure; D013902:Radiography, Thoracic / Q000295:instrumentation