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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.
Contributors KL and AK contributed to data collection, analysis and writing. RV obtained the echo imaging.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.