Superlow Cardiac Output

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.


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