We present a 43-year old female patient, admitted to the intensive care unit, recovering from a Bentall procedure because of a supra-coronary aneurysm and unicuspid aortic valve. Few hours following surgery,a marked lactic acidosis, hypoxemia and increased central venous pressure developed. Pulmonary angio-CT was performed to exclude pulmonary embolism. Because of severe peripheral vasoconstriction, iodine contrast could only be administered through a narrow lumen central venous catheter, which limited the maximum flow rate to 1.5 ml/s. Images were performed with triggering in the pulmonary trunk. Review of the images showed no evidence for pulmonary embolism. Despite the low flow rate, a clear enhancement of the pulmonary artery was observed (up to 460 HU) (Fig. 1). Such an enhancement of the pulmonary artery is normally only achieved when injecting contrast at a flow rate of 4-5 ml/s. These perfect images, obtained at a low contrast flow rate in fact indicate severely impaired right ventricular function.
How to Cite:
Devos H, Goethals L, Verdries DE, Smet KD, Geeter FD, Mey JD. When Beauty Hides a Beast. JBR-BTR. 2014;97(3):192–5. DOI: http://doi.org/10.5334/jbr-btr.79