Intended for healthcare professionals

Endgames Spot Diagnosis

An abnormal post-procedure chest radiograph

BMJ 2016; 353 doi: (Published 29 April 2016) Cite this as: BMJ 2016;353:i2359
  1. Abhishek Maiti, resident physician, postgraduate year 21,
  2. Robert F Lodato, professor2
  1. 1Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
  2. 2Department of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health Science Center at Houston
  1. Correspondence to: A Maiti abhishek.maiti{at}

A 55 year old man with lymphoma was admitted to the intensive care unit with severe sepsis and hypoxic respiratory failure as a result of healthcare associated pneumonia. At admission he had altered mental status and soon afterwards developed an episode of unstable bradycardia when his mean arterial pressure dropped to 26 mm Hg, and oxygen saturation dropped to 62% on 6 L oxygen through a nasal cannula. He underwent emergent endotracheal intubation, ultrasound guided right internal jugular central venous catheter (CVC) and left radial …

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