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‘Pulsatile’ vein in a man after a motor vehicle accident
  1. Kan Liu,
  2. Robert Voelker,
  3. Arunpreet Kahlon
  1. State University of New York, Upstate Medical University, Syracuse, New York, USA
  1. Correspondence to Dr Kan Liu, Division of Cardiology, Heart and Vascular Center, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY 13202, USA; liuk{at}upstate.edu

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Clinical introduction

A 57-year-old man with a motor vehicle accident and blunt chest trauma developed refractory hypotension and hypoxia. His external jugular veins were filled, pulsated with an indiscernible waveform. It was difficult to insert a central line into right subclavian vein, because of exceedingly brisk and pulsatile backward blood flow. No murmur was audible in auscultation. No specific cardiac abnormality was indicated in chest X-ray. Creatine kinase-MB was 30.89 and cardiac troponin T (CTnT) was 0.6. The ECG revealed an intermittent right bundle branch block pattern (see online supplementary figure S1). A subcostal view transthoracic echocardiogram with pulse wave Doppler study was shown in Figure 1A (a colour Doppler study was shown in online supplementary video 1). A contrast chest CT was shown in Figure 1B.

Figure 1

(A) Hepatic vein pulse wave …

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