Presentation
Shortness of breath and chest tightness for one day. Respiratory rate 28, raised D-dimer, ? pulmonary embolus.
Patient Data
There has been an arterial injection of contrast with opacification of the subclavian artery, internal mammary artery and multiple small arteries within the right scapular region.
Contrast has also opacified the right subclavian vein and right heart chambers, but there is only poor opacification of the pulmonary arterial tree.
The patient's cannula was examined, which was spouting arterial blood, and removed.
A new cannula was sited in the left antecubital fossa and a repeat scan was performed.
This shows a venous injection of contrast with adequate opacification of the pulmonary arterial tree.
No pulmonary embolism was identified.
Case Discussion
Inadvertent intra-arterial injection of contrast will lead to abnormal patterns of opacification and if noticed, should prompt the patient's "venous access" to be rechecked.
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