Hickman line

Date: 6 August 2015

Chest Xray showing the normal course of a Hickman line

Copyright: n/a

Notes:

Chest Xray showing the normal course of a Hickman line, usually used for delivering intravenous medication, and taking blood, in leukaemia patients. The line as shown is partly in the body and partly over the skin of the chest. The Hickman line is placed just below the clavicle (collar bone) on the patients right side (it can be on the left) into the subclavian vein. It is then fed through to the superior vena cava which drains blood from the upper body, head and neck into the heart. The end of the line lies in the superior vena cava about 6 inches (15 cm) above the heart (right atrium).


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    CT thorax, after 2 weeks high dose erythromycin,  showing a 2.8cm speculated lesion in the right upper lobe with a further 1.6cm similar mass on the left upper lobe also with a tendency for a central cavitation, and ill defined consolidation involving the peripheral aspect of both upper lobes and to a lesser extent right middle and both lower lobes.

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    A 71 year old woman presents with persistent dry cough. Her second CT scan of thorax shows lesions in the right and left upper lobes with ill defined consolidation in other areas (see images 3a, 3b and 3c). A PET scan is positive. She underwent right thoracotomy and sub-lobar wedge resection. Aspergillus grown from tissue and sputum grows Pseudomonas. Histology confirms the nodule to be non-small cell carcinoma (adenocarcinoma) but other lung areas show organizing pneumonia and another abscess formation with a cluster of branching septate hyphae. Despite starting itraconazole and oral ciprofloxacin she deteriorated with Type 1 respiratory failure. She was intubated and ventilated and switched to intravenous voriconazole and ceftazidime. She developed acute renal failure and then Enterococcus faecium bacteremia and she died 3 days later.

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