Presentation
In ICU post-coronary artery graft surgery (CAGS).
Patient Data
The patient is intubated, has a right internal jugular Swan-Ganz catheter overlying the pulmonary trunk as well as mediastinal drains.
Minor patchy opacity is present in the left lung base. The remainder of the lungs and pleural spaces are clear.
Swan-Ganz catheter now lies in the left pulmonary artery.
Moderate bilateral effusions have developed, slightly larger on the right.
Volume loss in the left lower lobe persists.
The Swan-Ganz catheter has been pulled back into the SVC. The mediastinal drain has been removed.
Bibasal collapse/consolidation has worsened, greater on the right. Moderate bilateral pleural effusions persist.
Case Discussion
This case (three consecutive chest x-rays whilst the patient recovers in ICU) demonstrates three different positions of Swan-Ganz catheter tips.