1/24. Persistent hypoxia after diagnosis and treatment of pulmonary thromboembolism.Acute respiratory failure in the perioperative period represents a frequent challenge to the anesthesiologist. The differential diagnosis is extensive and includes alterations on the pulmonary parenchyma, pulmonary vessels, airway, and cardiac system. Occasionally, two or more pathophysiological process superimpose. We present a patient who suffered from a left pulmonary embolism that was appropriately diagnosed and treated. However, the hypoxemia persisted and a second pathology was suspected. After careful evaluation and differential diagnosis, we drained a right pleural effusion, which had been present preoperatively, with resolution of the hypoxemia. There is controversy in the literature as to the role of drainage of pleural effusions on improving oxygenation. We present this case as an example of successful management of perioperative respiratory failure by thoracentesis in the presence of a second concurrent pathologic process.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/24. Retropericardial hematoma complicating off-pump coronary artery bypass surgery.We report the case of a retropericardial hematoma after triple-vessel off-pump coronary artery bypass grafting. Transesophageal echocardiography demonstrated a retropericardial hematoma that compressed the left atrium anteriorly and suppressed cardiac function. Injury to the pulmonary vein during placement of deep pericardial sutures and postoperative infusion of heparin were the likely causes of this rare but potentially fatal complication of an off-pump bypass operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/24. Complex, traumatic rupture of the thoracic aorta in a child: diagnostic findings and delayed surgery.We report the unusual case of a 4-year-old girl with traumatic aortic rupture. A conventional chest X-ray showed an enlarged mediastinum. Spiral CT and transthoracic echocardiography demonstrated a mediastinal hematoma, bilateral pleural effusion, and a rupture of the aortic arch. Semi-elective surgery, 4 days after the accident, confirmed rupture of the aortic arch with dislocation of the left carotid artery and the Ductus of Botalli. The vessels were subsequently repaired without complication. After a follow-up of 10 months, the child has fully recovered.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/24. Pulmonary capillary hemangiomatosis associated with primary pulmonary hypertension: report of 2 new cases and review of 35 cases from the literature.Pulmonary capillary hemangiomatosis (PCH) is a rare cause of primary pulmonary hypertension characterized by thin-walled microvessels infiltrating the peribronchial and perivascular interstitium, the lung parenchyma, and the pleura. These proliferating microvessels are prone to bleeding, resulting in accumulation of hemosiderin-laden macrophages in alveolar spaces. Here we report 2 cases of PCH with pulmonary hypertension, 1 of them associated with mechanical intravascular hemolysis, a feature previously reported in other hemangiomatous diseases, but not in PCH. Case 2 was diagnosed by pulmonary biopsy; to our knowledge the patient is the second adult to be treated with interferon alpha-2a. review of the literature identified 35 patients with PCH and pulmonary hypertension. The prognosis is poor and median survival was 3 years from the first clinical manifestation. dyspnea and right heart failure are the most common findings of the disease. hemoptysis, pleural effusion, acropachy, and signs of pulmonary capillary hypertension are less common. Chest X-ray or computed tomography scan usually shows evidence of interstitial infiltrates, pulmonary nodules, or pleural effusion. Hemodynamic features include normal wedge pressures. Radiologic and hemodynamic findings are undifferentiated from those of pulmonary veno-occlusive disease but differ from other causes of primary pulmonary hypertension. epoprostenol therapy, considered the treatment of choice in patients with primary pulmonary hypertension, may produce pulmonary edema and is contraindicated in patients with PCH. Regression of lesions was reported in 1 patient treated with interferon therapy and 2 other patients stabilized, including our second patient. PCH was treated successfully by lung transplantation in 5 cases. Early recognition of PCH in patients with suspected primary pulmonary hypertension is possible based on clinical and radiologic characteristics. diagnosis by pulmonary biopsy is essential for allowing appropriate treatment.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/24. Small vessel vasculitis limited to pleuropulmonary manifestations, possibly induced by endotoxin.AIMS: We investigated a rare case of small vessel vasculitis (SVV) limited to pleuropulmonary manifestations, possibly induced by endotoxin, to determine the activation of immuno-mediated cells and endothelia in the pleuropulmonary circulation. methods AND RESULTS: A 44-year-old man with a high fever was X-rayed, revealing bilateral pleural effusion and atelectasis in the chest. His laboratory data were within normal limits except for a high white blood cell count and a high c-reactive protein level. autoantibodies including anti-neutrophil cytoplasmic antibody were negative. Endotoxin was detected in his sera, but repeated cultures of sputa, urine, blood and the pleural effusion were negative for bacteria. Video-assisted thoracic surgery was performed and lung and parietal pleura specimens were obtained. histology showed arterioles or small arteries infiltrated by monocytes or neutrophils with fibrinoid necrosis and acute or chronic venulitis. A diagnosis of SVV in the lung and pleura was made. immunohistochemistry revealed that interleukin (IL)-1beta was expressed in monocytes and vascular cell adhesion molecule (VCAM)-1 on endothelial cells in the vasculitic lesions in the lung. CONCLUSIONS: Endotoxin possibly induced the inflammation in this apparently unique case of pleuropulmonary small vessel vasculitis. immunohistochemistry revealed the expression of IL-1beta and VCAM-1 which may have caused activation of monocytes and endothelial cells within the vasculitic lesions.- - - - - - - - - - ranking = 6keywords = vessel (Clic here for more details about this article) |
6/24. Isolated unilateral pleural effusion as the only manifestation of the ovarian hyperstimulation syndrome.Isolated unilateral pleural effusion is uncommon presentation of ovarian hyper stimulation syndrome. The pathogenesis of this syndrome involved an increased permeability of the ovarian capillaries and of the mesothelial vessels triggered by the release of vasoactive substances by the ovaries under human chorionic gonadotropin stimulation. Early recognition of this unusual presentation of ovarian hyperstimulation syndrome should allow for physicians to ensure a better and minimally invasive management of these potentially pregnant patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/24. Immune complex vasculitis as a cause of ascites and pleural effusions in systemic lupus erythematosus.A patient is described with systemic lupus erythematosus and large painless ascites and pleural effusions. Pleural and peritoneal fluid complement levels were depressed, and dna binding was elevated in the presence of normal serum values. Immunoglobulin and complement deposits were demonstrated in vessels of the pleura, peritoneum, and skin, along with histologic evidence of vasculitis. The relation of the ascites and pleural effusions to the presence of widespread vasculitis and local immune complex formation is discussed. These complications responded poorly to corticosteroid therapy but slowly resolved following the addition of an immunosuppressive agent.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/24. Late bleeding from right internal mammary artery after HeartMate left ventricular assist device implantation.Postoperative bleeding is one of the major complications after implantation of left ventricular assist devices. We experienced 5 unusual cases, which had bleeding from the right internal mammary artery between 5 and 69 days after implantation of a HeartMate (Thoratec Corporation, Pleasanton, CA) device. It was evident that the outflow graft had eroded through the vessel. Sudden decreases in device flow, hypotension, bleeding from the driveline or chest tube sites, and a drop in hematocrit were the initial manifestations. Chest roentgenogram and transthoracic echocardiography were effective in identifying hemothorax and cardiac tamponade. Four out of 5 patients survived to heart transplantation and were discharged from the hospital. When identified and treated appropriately, this complication does not impair patient outcome.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/24. Fatal sepsis following peripheral intravenous cannula embolus.This is a case report of multiple septic complications of a peripheral intravenous cannula as a direct result of proximal embolization of a fragment of the cannula to the heart and major vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/24. postpericardiotomy syndrome after minimally invasive repair of pectus excavatum.Minimally invasive repair of pectus excavatum (MIRPE) was first reported in 1998 and has gained wide acceptance since then. A 17-year-old girl who had undergone thoracotomy and cardiac surgery for transposition of great vessels at the age of 18 months presented with a deep, long pectus excavatum with asymmetry. After initial uneventful postoperative clinical course after MIRPE, the patient had bilateral pleural and pericardial effusion on the sixth postoperative day. Suspecting postpericardiotomy syndrome, systemic steroids were administered, and the symptoms resolved without affecting wound healing. Manifestation of a pericardial effusion combined with bilateral pleural effusion after MIRPE, especially in patients after cardiac surgery, may indicate a postpericardiotomy syndrome that can be treated successfully by intravenous steroids.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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