Texas Heart Institute journal
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Air embolism is rare and potentially fatal. Its early recognition and prompt treatment can help to prevent life-threatening sequelae. Herein, we report the case of a 75-year-old man who underwent a computed tomographic-guided lung biopsy of a left-lower-lobe pulmonary nodule. ⋯ After 4 hours, computed tomography revealed that the air had been absorbed into the circulation. The patient had no residual neurologic deficits. In addition to reporting this case, we discuss possible causes of air embolism and the management of the condition after percutaneous lung biopsy.
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Mounier-Kuhn syndrome, or tracheobronchomegaly, is a rare clinical and radiologic condition characterized by marked tracheobronchial dilation and recurrent lower respiratory tract infections. Diagnosis is typically accomplished with the use of computed tomography and bronchoscopy, as well as pulmonary function testing. Patients may be asymptomatic; however, symptoms can range from minimal with preserved lung function to severe respiratory failure. ⋯ Histopathologic examination of biopsy specimens from the bronchi and the tracheal wall supported the diagnosis of Mounier-Kuhn syndrome. The patient was released from the hospital and his condition was monitored for 2 years, during which time he developed no lower respiratory tract infections. Regardless of radiologic findings that suggest recurrent lower respiratory tract infection, we recommend that Mounier-Kuhn syndrome be considered in the differential diagnosis.
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Case Reports
Hypotension due to dynamic left ventricular outflow tract obstruction after percutaneous coronary intervention.
Persistent hypotension subsequent to percutaneous coronary intervention is attributed to access-site bleeding, re-infarction, or mechanical complications either of myocardial infarction or of the procedure itself (for example, pericardial tamponade). Dynamic left ventricular outflow tract obstruction after an uncomplicated percutaneous coronary intervention is an unusual, and to our knowledge not previously reported, complication that manifests itself as hypotension refractory to the usual therapy with inotropic agents. We discuss the clinical course, pathophysiology, diagnosis, and management of hypotension due to left ventricular outflow tract obstruction after percutaneous coronary intervention. Early recognition and accurate diagnosis that determines appropriate therapy will improve the patient's prospects.
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A 45-year-old man underwent repair of a congenital bicuspid aortic valve and complex aortic-root aneurysm with an aortic-root xenograft. A CentriMag® left ventricular assist device was implanted for cardiac support and was subsequently replaced with a HeartMate II® left ventricular assist device. ⋯ The patient underwent thrombus removal, oversewing of the prosthetic valve, and bypass of the left anterior descending coronary artery. This case emphasizes the hazard of bypassing a failed left ventricle with a cardiac assist device after aortic valve replacement, even with a bioprosthesis.