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.

Reappearing Gallbladder

Unfortunately, this is an all too common complication of cholecystectomy. This case is unusually unfortunate because the abscess tracks all the way through the porta hepatis and appears to tunnel through the wall of the adjacent 2nd part of the duodenum. Not wanting to feel left out, the laparoscopic port sites in the anterior abdominal wall also developed abscesses (right upper quadrant and periumbilical). Incidental calcified aneurysm of one of the small mesenteric vessels can be seen anterior to the aorta.

This just goes to prove that a minor procedure is when it happens to someone else.

Digital kit cat clock update: OLED


I really love the Nokia 5100 display but wanted to try different varieties.  This is an SSD1306 0.96″ OLED display.  Resolution is 128 x 64 so significantly larger than the pixel size of the Nokia.


The contrast on the OLED is striking, so much so that it is difficult to photograph.  There will probably be more changes to the formatting and layout but the underlying code is the same as previous iterations of the clock with OTA updates, NTP sync, and WiFi Manager.

Taco Friday! Taco Mesh


There is a really good chance that your mesh hernia repair will fail if the mesh is folded up like a taco rather than attached to the abdominal wall. As the image scrolls towards the bottom, the higher density Chevron shaped object contacting the anterior abdominal wall (and I use all of those terms loosely, pun intended) is the mesh.

Note the small bowel obstruction which is unrelated to the recurrent hernia and probably adhesive. Interestingly, the hernia does contain a loop of sigmoid colon which appears nonplussed by the adjacent wad of mesh.

On the upside…no abscess!