Correspondence
Idiopathic Clubbing
N Engl J Med 2001; 344:611February 22, 2001
- Article
To the Editor:
With respect to the Image in Clinical Medicine entitled “Idiopathic Clubbing” (Oct. 26 issue),1 it seems difficult to justify the use of right heart catheterization, a technique with a recognized risk of complications and even of death,2 in the investigation of an asymptomatic clinical finding that had been unchanged for the better part of four decades. It may be that the clinicians did have a good reason to proceed with this investigation, but if so, it was not stated.
2 ReferencesPhilip Baragwanath, M.D.
Leicester General Hospital, Leicester LE5 4PW, United Kingdom1
Reynen K ,Daniel WG . Idiopathic clubbing. N Engl J Med 2000;343:1235-1235
Full Text | Web of Science | Medline2
Boyd KD ,Thomas SJ ,Gold J ,Boyd AD . A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients. Chest 1983;84:245-249
CrossRef | Web of Science | Medline
Author/Editor Response
Dr. Reynen and a colleague reply:
To the Editor: Boyd et al.1 reported a substantial risk of complications associated with the use of Swan–Ganz catheters in patients who had had surgical procedures or in those with hemodynamic instability. The catheters were in place for an average of 1.8 days (range, 4 hours to 9 days), the rate of serious complications amounted to 4.4 percent, and the complications were septic, pulmonary (hemorrhage and infiltrates), and cardiac (ventricular tachycardia) in nature. The rate of complications associated with diagnostic right heart catheterization, however, is very low (about 0.15 percent), with no risk of death.2 Our patient, who had marked clubbing of the digits, underwent diagnostic right heart catheterization even though cyanosis was not apparent clinically. On noninvasive assessment, all cardiac and pulmonary findings were normal; the possibility of pulmonary-artery hypertension and intracardiac shunting, however, had to be excluded with certainty, since the patient wanted to go scuba diving.
2 ReferencesKlaus Reynen, M.D.
Ruth H. Strasser, M.D.
Heart Center Dresden, 01307 Dresden, Germany1
Boyd KD ,Thomas SJ ,Gold J ,Boyd AD . A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients. Chest 1983;84:245-249
CrossRef | Web of Science | Medline2
de Bono D . Complications of diagnostic cardiac catheterisation: results from 34,041 patients in the United Kingdom confidential enquiry into cardiac catheter complications. Br Heart J 1993;70:297-300
CrossRef | Web of Science | Medline
