Pitfalls of computed tomography angiography examination in veno-arterial extracorporeal membrane oxygenation patients: a case report of a patient with cardiac rupture
Abstract Background Veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) is commonly used for patients with cardiac arrest, cardiogenic shock, or heart failure and is a life-saving technique. Computed tomography angiography (CTA) examination in patients on ECMO presents certain challenges....
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-12-01
|
| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-03206-8 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841559148285657088 |
|---|---|
| author | Hua-Liang Ying Hui Zhao Chao Zhang Mengyuan Zhang Weijun Song Yongpo Jiang |
| author_facet | Hua-Liang Ying Hui Zhao Chao Zhang Mengyuan Zhang Weijun Song Yongpo Jiang |
| author_sort | Hua-Liang Ying |
| collection | DOAJ |
| description | Abstract Background Veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) is commonly used for patients with cardiac arrest, cardiogenic shock, or heart failure and is a life-saving technique. Computed tomography angiography (CTA) examination in patients on ECMO presents certain challenges. Due to the dual circulation characteristics of blood flow in ECMO patients, vascular imaging and interpretation can be difficult and may even present pitfalls. Case presentation A 59-year-old male was admitted with a diagnosis of cardiogenic shock due to “sudden onset of chest discomfort for 6 hours and altered mental status for 4 hours”. He underwent V-A ECMO treatment twice and had two aortic CTA examinations. The initial CTA mistakenly diagnosed an aortic dissection. Considering the dual circulation blood flow characteristic in ECMO patients, a second CTA was performed. Combined with echocardiography, the patient was accurately diagnosed with left ventricular rupture and underwent left ventricular rupture repair surgery. The patient was successfully weaned off ECMO, transferred out of the ICU, and eventually discharged in good condition. Conclusion The unique hemodynamics of V-A ECMO patients necessitate interpreting CTA examinations with an understanding of the dual circulation characteristic to avoid misdiagnosis. |
| format | Article |
| id | doaj-art-7d96c7cde4594101a89c04fc3e184eb9 |
| institution | Kabale University |
| issn | 1749-8090 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-7d96c7cde4594101a89c04fc3e184eb92025-01-05T12:45:47ZengBMCJournal of Cardiothoracic Surgery1749-80902024-12-011911410.1186/s13019-024-03206-8Pitfalls of computed tomography angiography examination in veno-arterial extracorporeal membrane oxygenation patients: a case report of a patient with cardiac ruptureHua-Liang Ying0Hui Zhao1Chao Zhang2Mengyuan Zhang3Weijun Song4Yongpo Jiang5Department of Critical Care, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityDepartment of Critical Care, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityDepartment of Critical Care, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityDepartment of Critical Care, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityDepartment of Critical Care, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityDepartment of Critical Care, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityAbstract Background Veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) is commonly used for patients with cardiac arrest, cardiogenic shock, or heart failure and is a life-saving technique. Computed tomography angiography (CTA) examination in patients on ECMO presents certain challenges. Due to the dual circulation characteristics of blood flow in ECMO patients, vascular imaging and interpretation can be difficult and may even present pitfalls. Case presentation A 59-year-old male was admitted with a diagnosis of cardiogenic shock due to “sudden onset of chest discomfort for 6 hours and altered mental status for 4 hours”. He underwent V-A ECMO treatment twice and had two aortic CTA examinations. The initial CTA mistakenly diagnosed an aortic dissection. Considering the dual circulation blood flow characteristic in ECMO patients, a second CTA was performed. Combined with echocardiography, the patient was accurately diagnosed with left ventricular rupture and underwent left ventricular rupture repair surgery. The patient was successfully weaned off ECMO, transferred out of the ICU, and eventually discharged in good condition. Conclusion The unique hemodynamics of V-A ECMO patients necessitate interpreting CTA examinations with an understanding of the dual circulation characteristic to avoid misdiagnosis.https://doi.org/10.1186/s13019-024-03206-8Extracorporeal membrane oxygenationComputed tomography angiographyWatershedCardiac rupturePitfalls |
| spellingShingle | Hua-Liang Ying Hui Zhao Chao Zhang Mengyuan Zhang Weijun Song Yongpo Jiang Pitfalls of computed tomography angiography examination in veno-arterial extracorporeal membrane oxygenation patients: a case report of a patient with cardiac rupture Journal of Cardiothoracic Surgery Extracorporeal membrane oxygenation Computed tomography angiography Watershed Cardiac rupture Pitfalls |
| title | Pitfalls of computed tomography angiography examination in veno-arterial extracorporeal membrane oxygenation patients: a case report of a patient with cardiac rupture |
| title_full | Pitfalls of computed tomography angiography examination in veno-arterial extracorporeal membrane oxygenation patients: a case report of a patient with cardiac rupture |
| title_fullStr | Pitfalls of computed tomography angiography examination in veno-arterial extracorporeal membrane oxygenation patients: a case report of a patient with cardiac rupture |
| title_full_unstemmed | Pitfalls of computed tomography angiography examination in veno-arterial extracorporeal membrane oxygenation patients: a case report of a patient with cardiac rupture |
| title_short | Pitfalls of computed tomography angiography examination in veno-arterial extracorporeal membrane oxygenation patients: a case report of a patient with cardiac rupture |
| title_sort | pitfalls of computed tomography angiography examination in veno arterial extracorporeal membrane oxygenation patients a case report of a patient with cardiac rupture |
| topic | Extracorporeal membrane oxygenation Computed tomography angiography Watershed Cardiac rupture Pitfalls |
| url | https://doi.org/10.1186/s13019-024-03206-8 |
| work_keys_str_mv | AT hualiangying pitfallsofcomputedtomographyangiographyexaminationinvenoarterialextracorporealmembraneoxygenationpatientsacasereportofapatientwithcardiacrupture AT huizhao pitfallsofcomputedtomographyangiographyexaminationinvenoarterialextracorporealmembraneoxygenationpatientsacasereportofapatientwithcardiacrupture AT chaozhang pitfallsofcomputedtomographyangiographyexaminationinvenoarterialextracorporealmembraneoxygenationpatientsacasereportofapatientwithcardiacrupture AT mengyuanzhang pitfallsofcomputedtomographyangiographyexaminationinvenoarterialextracorporealmembraneoxygenationpatientsacasereportofapatientwithcardiacrupture AT weijunsong pitfallsofcomputedtomographyangiographyexaminationinvenoarterialextracorporealmembraneoxygenationpatientsacasereportofapatientwithcardiacrupture AT yongpojiang pitfallsofcomputedtomographyangiographyexaminationinvenoarterialextracorporealmembraneoxygenationpatientsacasereportofapatientwithcardiacrupture |