I can’t say I remember ever seeing this physiology at contrast injection before. I’d say the contrast injector is doing the vast majority of pumping in this patient.
The salient points are:
- Insane volume overload with effusions, ascites and anasarca.
- Injected contrast barely even makes it into the RV.
- Contrast refluxes into the azygos vein which is common.
- What is unusual is reflux through the coronary sinus into the posterior basal segment lower lobe pulmonary veins opacifing the collapsed lung parenchyma.
- But contrast does not stop there… There is reflux into all 3 hepatic veins and into the posterior right hepatic lobe parenchyma, the right adrenal veins, and the right renal veins producing a branching pattern that could be mistaken for excreted contrast if not for the unilaterality.
- There is even contrast into retroperitoneal veins and lumbar veins.
In sum, cardiac output could probably be measured with a TB syringe.