scholarly journals 759 Platypnoea orthodeoxia syndrome following middle-lower bilobectomy: a case report

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Paolo Spontoni ◽  
Laura Stazzoni ◽  
Cristina Giannini ◽  
Giulia Costa ◽  
Marco Angelillis ◽  
...  
Keyword(s):  
Supine Position ◽  
Clinical Manifestations ◽  
Lower Lobe ◽  
Treatment Modalities ◽  
Valsalva Manoeuvre ◽  
Arterial Blood Gas ◽  
Cardiac Catheterization Laboratory ◽  
The Third ◽  
Arterial Blood ◽  
The Right

Abstract Aims PlatypneaOrthodeoxiasyndrome (POS) is a rare clinical condition characterized by dyspnoea and arterial desaturation, typically occurring in orthostatism and vanishing in a supine position. The real pathophysiologic triggers are still not completely understood. Methods and results In January 2021, a 76-year-old female patient was admitted to our department for the management of a large mass in the right lung (69 × 54 × 76 cm). Pre-operative Computed Tomography (CT)-scan showed a lesion of the right lower lobe, with suspected infiltration of posterior costal pleura and bronchoscopy revealed distal occlusion of intermedious bronchus. Surgical treatment was planned: extrapleural lower bilobectomy with the removal of the VI rib to reduce intracavity space was performed, using postero-lateral thoracotomy approach. On the third post-operative day, an acute neurologic deficit with left-sided paralysis, associated with desaturation and hypotension, occurred during a new attempt to mobilize the patient. Nonetheless the patient showed complete resolution of symptoms in supine position. A new similar episode of severe desaturation (SO2 80%) was observed in the 7th post-operative day. Arterial blood gas test showed PO2 37 mmHg; PCO2 27 mmHg; SO2 80.3%, pH 7.61, tHb 12.4 g/dl; O2Hb 78.4%. CT pulmonary angiography excluded a suspicious of pulmonary embolism. A right to left atrial shunt was suspected. Contrast-enhanced transcranial Doppler ultrasound showed microembolic signals in the basal cerebral arteries. Transoesophageal echocardiography was performed, confirming an interatrial septum with an exuberant hyperdynamic movement and showing an abundant passage of contrast from the right atrium to the left, even without the Valsalva manoeuvre, compatible with an important patent foramen ovale (PFO). Patient was referred to the cardiac Catheterization Laboratory for percutaneous closure of PFO. The device was successfully placed via right femoral venous catheter access and on transesophageal echocardiogram guidance. The procedure was performed without any complications. The implanted device was noted to be in a stable position with trivial residual inter-atrial shunting immediately after the procedure. The day after implantation, positional discomfort improved remarkably and the patient was able to stand-up with no symptoms, maintaining normal saturation (SaO2 100%). The patient was discharged and sent home on the third post-implantation day. The 4 month follow-up examination showed a good andstable condition. Conclusions Platypnoea Orthodeoxia Syndrome after lobectomy is a rare cause of postoperative dyspnoea/hypoxia.It is the result of right-to-left shunt via interatrial communication. Mediastinal relocation, stretching of the atrial septum are among the functional elements necessary for the clinical manifestations. It is essential to have a high index of suspicion to detect POS in patient with dyspnoea given the subtle and positional nature of the symptoms. Physicians should always consider POS in patients with unexplained dyspnoea; hence the treatment modalities could alleviate symptoms and be potentially curative.

scholarly journals Effect of Recruitment and Body Positioning on Lung Volume and Oxygenation in Acute Lung Injury Model

2008 ◽  
Vol 36 (6) ◽  
pp. 792-797 ◽  
Author(s):  
H. G. Ryu ◽  
J.-H. Bahk ◽  
H.-J. Lee ◽  
J.-G. Im
Keyword(s):  
Acute Lung Injury ◽  
Oleic Acid ◽  
Lung Injury ◽  
Lung Volume ◽  
Supine Position ◽  
Recruitment Manoeuvre ◽  
Prone Positioning ◽  
Dependent Lung ◽  
Arterial Blood Gas ◽  
Arterial Blood

The mechanism of oxygenation improvement after recruitment manoeuvres or prone positioning in acute lung injury or acute respiratory distress syndrome is still unclear. We tried to determine the mechanism responsible for the effects of recruitment manoeuvres or prone positioning on lung aeration using a whole lung computed tomography scan in an oleic acid induced acute lung injury canine model. Twelve adult mongrel dogs were allocated into either the supine group (n=6) or the prone group (n = 6). After the establishment of acute lung injury, three recruitment manoeuvres were performed at one-hour intervals. Haemodynamic and ventilatory variables, arterial blood gas analyses and CT scans of the whole lung were obtained 90 minutes after oleic acid injection and five minutes before and after each recruitment manoeuvre. Recruitment manoeuvres in the supine position improved oxygenation (P=0.025) that correlated with increase of the poorly- and well-aerated dorsal (dependent) lung volume (r=0.436, P=0.016). Prone positioning increased oxygenation (P=0.004) that also correlated with increase of the poorly- and well-aerated dorsal (nondependent) lung volume (r=0.787, P <0.001). However, the recruitment manoeuvre in the prone position had no effect on oxygenation despite an increase in ventral (dependent) lung volume. The increase in PO2 after recruitment manoeuvres in the supine position or after prone positioning is related to the increase of the poorly- and well-aerated dorsal lung.

scholarly journals Intralobar pulmonary sequestrations in adults

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Lower Lobe ◽  
Pulmonary Sequestration ◽  
Military Hospital ◽  
Lateral Side ◽  
Intralobar Sequestration ◽  
Arterial Blood ◽  
Systemic Artery ◽  
Clinical Presentations ◽  
Chest X Ray ◽  
The Right

Intralobar sequestration accounts for 75% of pulmonary sequestrations. It is characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply. We conducted a retrospective medical records review of all patients evaluated and treated in our pulmonary department of military hospital of Tunisia with diagnosis of PS from January 2007 through December 2015. Among them, we report 5 cases of intralobar pulmonary sequestrations operated. There are three women and two men; the mean age is 27.6 years. The sequestration was intralobar in all cases. Clinical presentations were chest pain and productive cough in three cases. Chest X-ray showed left basal opacity in three cases, bilateral basal reticulonodular opacities in one case and round hydric opacity in the right lower lobe in one other case. Computed tomography was performed and revealed an aberrant systemic artery born from the lateral side of aorta supplying a left lower lobe sequestration in four cases and a right lower lobe mass in only one case. The confirmation was operative in all cases and histologic only in three cases. All patients were treated by lobectomy. Only one case presented with a pulmonary sequestration combined with tuberculosis and he was treated firstly by antituberculous chemotherapy. The results were excellent with a favorable clinical course and the mortality was nil.

scholarly journals An Accidental Discovery of Tracheobronchomegaly: a Case Report

2020 ◽  
Author(s):  
Weijiang Ma ◽  
Aihua Liu ◽  
Xin Liu ◽  
Fukai Bao
Keyword(s):  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Clinical Manifestations ◽  
Lower Lobe ◽  
Image Features ◽  
Surgical Measures ◽  
The Right ◽  
Chest Ct Scan ◽  
Video Assisted Thoracoscopic Surgery ◽  
Accidental Discovery

Abstract Tracheobronchomegaly is a rare disease with congenital abnormal change in respiratory tract; its image features are also very special. In this case, we described a 57-year-old male with cough, expectoration, chest pain, and dyspnea. In our institution, the result of chest CT scan is highly extraordinary, which showed obvious dilation of the trachea and main bronchi, emphysema, and a number of pulmonary bullae, and there was a big bulla with air-fluid level on the lower lobe of the right lung. Fortunately, after wedge resection for the big bulla on the lower lobe of right lung under video-assisted thoracoscopic surgery, this patient’s symptoms were significantly relieved. The clinical manifestations of tracheobronchomegaly lack specificity; this disease has freakish image features. At present, there are no effective treatments for tracheobronchomegaly, which just was an accidental discovery in this patient; we just mainly take surgical measures to treat the big bulla for relieving symptoms.

scholarly journals Coronavirus disease 19 with gastrointestinal symptoms as initial manifestations: a case report

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095225
Author(s):  
Chun-Yang Wu ◽  
Xiao-Pin Yu ◽  
Ada Hoi Yan Ma ◽  
Li-Ping Wang ◽  
Nai-Bin Yang ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Lower Lobe ◽  
Ground Glass Opacity ◽  
Chain Reaction ◽  
Chronic Superficial Gastritis ◽  
Polymerase Chain ◽  
The Right

Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019, an epidemic has spread rapidly worldwide. COVID-19 is caused by the highly infectious severe acute respiratory syndrome coronavirus-2. A 42-year-old woman presented to hospital who was suffering from epigastric discomfort and dyspepsia for the past 5 days. Before the onset of symptoms, she was healthy, and had no travel history to Wuhan or contact with laboratory-confirmed COVID-19 cases. An examination showed chronic superficial gastritis with erosion and esophagitis. Enhanced magnetic resonance imaging of the abdomen showed a lesion in the right lower lobe of the lungs. Chest computed tomography showed multiple ground-glass opacity in the lungs. Reverse transcription-polymerase chain reaction was negative for severe acute respiratory syndrome coronavirus-2. There was no improvement after antibiotic treatment. Polymerase chain reaction performed 2 days later was positive and she was diagnosed with COVID-19. After several days of antiviral and symptomatic treatments, her symptoms improved and she was discharged. None of the medical staff were infected. Clinical manifestations of COVID-19 are nonspecific, making differentiating it from other diseases difficult. This case shows the sequence in which symptoms developed in a patient with COVID-19 with gastrointestinal symptoms as initial manifestations.

Failure of hemoconcentration during standing to reveal plasma volume decline induced in the erect posture

1994 ◽  
Vol 77 (5) ◽  
pp. 2155-2162 ◽  
Author(s):  
J. Lundvall ◽  
P. Bjerkhoel
Keyword(s):  
Plasma Volume ◽  
Supine Position ◽  
Venous Blood ◽  
Control Level ◽  
Quiet Standing ◽  
Fluid Loss ◽  
Erect Posture ◽  
Arterial Blood ◽  
Dependent Position ◽  
The Right

The hypothesis was tested that the hemoconcentration observed during standing provides erroneous information about the induced plasma volume (PV) decline. Male volunteers (n = 10) stood quietly for 15 min after supine rest. On standing arterial hemoglobin (Hb) rose slowly to reach an increase of 5.9 +/- 0.3% (SE) after 15 min. Early after resuming the supine position, Hb increased further to 9.2 +/- 0.5% above control level and then declined gradually. Venous antecubital blood from the left arm supported horizontally at heart level in both the supine and standing positions (no hydrostatic load) showed very similar changes. However, Hb in venous blood collected during standing from the right arm held in the natural dependent position rose much more markedly than that in arterial blood and in venous blood from the horizontal arm (470 +/- 122, 105 +/- 24, and 55 +/- 7% greater increase at 5, 10, and 15 min, respectively). Taken together, these observations indicated that 1) analyses of arterial blood sampled from the standing subject grossly underestimated the prevailing “overall” hemoconcentration and PV decline, a phenomenon ascribed to incomplete mixing of blood between dependent and nondependent regions; 2) arterial blood sampled from the recumbent subject early (60 s) after completion of standing reflected the “true” overall intravascular hemoconcentration, with a calculated PV decline of no less than 511 +/- 27 ml, because the supine position facilitated proper mixing of blood between circulatory compartments; 3) data from common venous sampling from the dependent arm during standing primarily reflected a regional hemoconcentration (fluid loss) in the arm rather than PV decline; and 4) short-term quiet standing caused a more prominent and hemodynamically important decrease in PV than usually believed.

Late Silent Stent Abscess

Cardiology ◽  
2015 ◽  
Vol 132 (1) ◽  
pp. 65-67
Author(s):  
Dmitry Zateyshchikov ◽  
Elvira Fattakhova ◽  
Vladimir Demchinsky ◽  
Tatiana Baklanova ◽  
Victor Serebruany
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Manifestations ◽  
Bare Metal Stent ◽  
Fibrinolytic Therapy ◽  
Post Discharge ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Early Withdrawal ◽  
The Right

Background: Coronary stent infections in general and stent abscesses (SAs) in particular are rare but often deadly complications. Most SAs manifest with fever and chest pain within 30 days after intervention and require antibiotics and stent removal. Case Report: A 45-year-old man with second ST elevated myocardial infarction and cardiogenic shock was admitted to a hospital that had no cardiac catheterization laboratory. The patient underwent fibrinolytic therapy with alteplase but died 1 h later. His medical history revealed posterior myocardial infarction 7 years before, which had been successfully treated with a bare metal stent of the right coronary artery. The post-discharge observation had been unremarkable with no evidence of ischaemia or infection but gross non-compliance. Autopsy revealed complete closure of the left main coronary artery and a surprise additional finding, namely SA; the stented portion of the artery was enveloped by an abscess, and purulent material completely occluded the stent, which was floating in pus. Impressions: Since coronary angioplasty is so common, the incidence of late silent SA is probably higher than expected, especially considering that there is often a lack of clinical manifestations. Clinicians should be cognizant of this complication. More attention may be required to assess the condition of existing stents during repeated interventions. Gross non-compliance and/or early withdrawal from dual anti-platelet therapy may be directly responsible for the development of silent delayed SA.

scholarly journals Healthy blue man: congenital methemoglobinemia

2017 ◽  
Vol 5 (10) ◽  
pp. 4632
Author(s):  
B. V. Nagabhushana Rao ◽  
S. C. Sinha ◽  
S. Modi ◽  
S. Sunita
Keyword(s):  
Methylene Blue ◽  
Ascorbic Acid ◽  
Clinical Presentation ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Treatment Modalities ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

Congenital methemoglobinemia, though often discussed in medical teachings is rarely encountered in clinical practice as the condition is asymptomatic. Here we present such a case and discuss in detail the clinical presentation of both congenital and acquired methemoglobinemia. We also outlined the management of the conditions. One should suspect methemoglobinemia when cyanosis is not being corrected by supplementing oxygen and and when the oxygen saturation is low by pulse oximetry and normal by arterial blood gas analysis. Treatment modalities for congenital methemoglobinemia is of cosmetic purpose, but timely intervention in acquired methemoglobinemia could be lifesaving. Methylene blue, Ascorbic acid and Riboflavin are drugs of choice.

scholarly journals Use of an Endobronchial Blocker and Selective Lung Ventilation to Aid Surgical Removal of a Lung Lobe Abscess in a Dog

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Carl Bradbrook ◽  
Louise Clark ◽  
Martina Mosing
Keyword(s):  
Lung Ventilation ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Surgical Removal ◽  
Arterial Blood Gas ◽  
Lung Lobe ◽  
Lung Lobectomy ◽  
Arterial Blood ◽  
Endobronchial Blocker ◽  
The Right

This paper documents use of an endobronchial blocker (EBB) to achieve selective lung ventilation (SLV) for the purpose of lung lobectomy with thoracoscopy. A 3-year-old female neutered Labrador Retriever, body mass of 18.5 kg, was presented for exploratory thoracoscopy. Acepromazine and methadone were administered as premedication, and anaesthesia was induced with propofol and maintained with isoflurane in 100% oxygen and continuous infusions of fentanyl and lidocaine. Mechanical ventilation of the dog’s lungs was performed prior to placement of an Arndt EBB caudal to the right cranial bronchus to allow SLV. Successful SLV was achieved with this technique, allowing continued inflation of the right cranial lobe. A reduction in the arterial partial pressure of oxygen to fractional inspired oxygen ratio (PaO2 : FiO2) of 444 to 306 occurred after placement of the EBB, with no change in monitored cardiopulmonary variables. F-shunt increased from 17.4% to 23.7% with a reduction in oxygen content (CaO2) of 20.0 to 18.7 mg dL-1, remaining within the physiologic range. Due to lung adhesions to the diaphragm, conversion to thoracotomy was required for completion of the procedure. This technique is challenging to perform in the dog. Arterial blood gas analysis should be performed to allow adequate monitoring of ventilation.

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