Radiographic mislead: apparent arterial placement of subclav
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Case :
A 32-year-old lady with leiomyosarcoma of hand, underwent amputation of right forearm. On second postoperative day, her general condition gradually deteriorated. She was shifted to intensive care unit (ICU) in view of tachypnoea and desaturation to 84% on oxygen (60% byVenturi) support. She was haemodynamically unstable with a heart rate of 120/min and blood pressure (BP) of about 85/45 mmHg. Auscultation of chest revealed decreased air entry on the right side of chest. Patient did not co-operate for the noninvasive ventilation. She was intubated with a 7.0 mm internal diameter cuffed Portex© endotracheal tube (ETT) and started on dopamine infusion at 10 ?g/kg/min through 18 gauge peripheral intravenous (IV) line. A 15 cm seven French triple lumen CVC was secured in the right subclavian vein in first attempt using the Seldinger technique, and backflow of blood was confirmed in all three lumens. We planned to administer ionotropes through CVC once its placement was confirmed by a chest radiograph. Urgent portable chest radiograph was sought for and it showed CVC crossing the midline with gradual turn leftwards and downwards [Figure 1].......

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968658/
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