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Dependent Venous Contrast Pooling and Layering: A Sign of Imminent Cardiogenic Shock

Chris Roth1, Michael Sneider1, Naama Bogot1, Michael Todd1 and Paul Cronin1

1 All authors: Department of Radiology, University of Michigan Health Systems and University of Michigan Hospitals, B1 132F Taubman Center, 1500 E Medical Center Dr., TC 2910, Ann Arbor, MI 48109.


Figure 1
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  		Fig. 1A —63-year-old man after type A aortic dissection repair. CT image at level of left main pulmonary artery shows type A aortic dissection repair (black asterisk), pericardial thickening and fluid (arrow), a blood-contrast level within superior vena cava (arrowhead), and bilateral pleural effusions (white asterisks).

 

Figure 2
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  		Fig. 1B —63-year-old man after type A aortic dissection repair. Note presence of pericardial thickening (arrow), straightened interventricular septum (arrowhead), and small right ventricle (black asterisk).

 

Figure 3
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  		Fig. 1C —63-year-old man after type A aortic dissection repair. Dependent venous pooling of contrast material in dependent hepatic veins (arrows) and intrahepatic inferior vena cava (IVC) (black asterisk).

 

Figure 4
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  		Fig. 1D —63-year-old man after type A aortic dissection repair. Venous layering of contrast material and blood within lower abdominal IVC (arrowhead).

 

Figure 5
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  		Fig. 2A —87-year-old woman with acute myocardial infarction and congestive heart failure. Reflux of contrast material into dependently positioned right renal vein (asterisk).

 

Figure 6
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  		Fig. 2B —87-year-old woman with acute myocardial infarction and congestive heart failure. Composite image of two CT series shows venous pooling and layering of contrast material within superior vena cava, right atrium of heart, inferior vena cava, and other dependent venous structures.

 

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