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Case: 83 yo M complaining of malaise. Appears weak.
This case has two questions/tasks:
Click here for a hint The diagnosis is not to be had from the EKG alone
Click here for an easier hint You can make the diagnosis from the CXR
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EKG interpretation (click to view)
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CXR Day 0 (admission day) 4pm
Study Description: CH1/PO
Reason for Study: syncope
Body
No prior studies. Dual chamber pacemaker is adequately
positioned. Small lung volumes are bibasilar atelectasis. No air space
consolidation or frank pulmonary edema.
Impression: pacemaker. Small lung volumes with bibasilar atelectasis and vascular crowding
CXR Day 0 (admission day) 8:30pm
Study Description: CHPORT
Reason for Study: LINE REPLACEMENT
Body
The chest is overall improved since the previous study with a
new left subclavian line in place. No evidence for pneumothorax is present.
Pacemakers in place.
Impression: good position of the central line.
CXR Day 1
Study Description: CHPORT
Reason for Study: POST OP PACEMAKER
Clinical History: Postoperative pacemaker placement
Technique: A portable AP view of the chest was obtained.
Comparison: None
Findings: A pacing device is situated over the right anterior lateral chest wall. The pacer leads are situated over the right atrium and ventricle. There is pulmonary vascular congestion.
Impression: Pulmonary vascular congestion. Dual lead pacemaker placement as above.
CXR Day 2
Study Description: CHPORT
Reason for Study: 83 Y/O F PACEMAKER FAILURE
Body
There is no change in the appearance of the chest since the previous
examination. The various tubes remain in place.
Impression: No significant change.