Final Report:
Emergent coronary angiography in conjunction with angioplasty
intervention:
The 62 y/o female patient was transferred to Beth Israel Hospital for emergency catheterization because of an acute myocardial infarction. Procedure was performed by the cardiology service. For technical detail and results, see corresponding report.
Technical note: Isovue 76 as contrast agent, 36 minutes fluoroscopy.
Final Report:
HISTORY: s/p mi. s/p PTCA this a.m.
FINDINGS: We have no record of recent prior BIH chest radiograph for comparison. AP supine chest. The heart appears enlarged. There is upper zone redistribution and interstitial edema, with areas of more confluent air space disease in the right lower zone. This could represent atypical CHF, but aspiration cannot be excluded. ETT tip is approximately 2 cm above the carina. NG tube tip is below the diaphragm. Tip of Swan-Ganz catheter, which appears to have been introduced via femoral approach, lies in the right main pulmonary artery.
IMPRESSION: Moderate CHF. Superimposed consolidation cannot be excluded in the right mid zone.
Underlying Medical Condition: 62 year old woman with s/p mi, vf arrest, ? witnessed aspiration.
Final Report:
HISTORY: S/P vfib arrest. Possible witnessed aspiration.
FINDINGS: The ET tube has beem removed. The right femoral SG catheter tip lies in the right main pulmonary artery overlying the hilum. The NG tube is poorly visualized beyond the distal esophagus due to under penetration. There is mild cardiomegaly, without CHF. Compared with the film of one day previously, the CHF findings have resolved and the alveolar process in the right mid-zone has almost completely cleared.
IMPRESSION: Improved CHF. Resolution of right midzone infiltrate.
Final Report:
HISTORY: Shortness of breath, ?aspiration.
Upright view of the chest is compared to that done one day earlier. Swan-Ganz catheter is no longer visualized (femoral approach). No lines or tubes are seen. There is persistent cardiomegaly and mild pulmonary congestion. There may be a posterior layering left effusion. Overall, however, the exam appears unchanged.