A & A case reports
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Case Reports
Massive pulmonary embolism in pregnancy treated with catheter-directed tissue plasminogen activator.
Pulmonary embolism is a leading cause of maternal death in the United States, contributing to the death of approximately 2 women per 100,000 live births each year. Thrombosis during pregnancy traditionally is treated conservatively with unfractionated heparin or low-molecular-weight heparin; however, cardiovascular collapse associated with a large pulmonary embolus may require immediate aggressive intervention to save the mother and fetus. We report the use of catheter infusion thrombolysis in the successful management of a third-trimester pregnant patient with a hemodynamically significant saddle pulmonary embolus.
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Cardiofaciocutaneous syndrome is a rare syndrome that is characterized by distinct craniofacial features, cardiac abnormalities, and multiple organ involvement. Patients may present with pulmonary stenosis, hypertrophic cardiomyopathy, micrognathia, a short neck, laryngomalacia, and tracheomalacia; all of which may significantly impact the perioperative course of these patients. We describe a 6-year-old child with cardiofaciocutaneous syndrome presenting for an orthopedic procedure. He had an uneventful perioperative and postoperative course.
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We present the case of a 62-year-old woman with an advanced metastatic lung tumor that required palliative debulking. Perioperative placement of a surgical clip in the dura of the thoracic spinal cord caused a dural breach, which ultimately caused a pneumocephalus. An awareness of this association is important, especially in patients undergoing thoracic resections. We also describe our approach to the management of this condition.
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A patient with an endobronchial tumor and critical airway obstruction developed hypoxia and hypercarbia and, subsequently, cardiac arrest during a palliative laser core-out excision. The differential diagnosis included tension pneumothorax, as well as airway obstruction due to swelling of residual tumor or to blood clots. ⋯ Immediate bedside lung ultrasonography provided real-time information leading to the stabilization of the patient. This case provides compelling motivation for anesthesiologists to acquire this easily learned skill.
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A 56-year-old man with a history of coronary artery disease, 4 months of cough and shortness of breath, a new lung mass, and increasing hypoxemia presented to the operating room emergently for a subxiphoid pericardial window for cardiac tamponade. After 1200 mL of pericardial fluid was drained, the patient immediately went into acutely decompensated right heart failure as seen on a transesophageal echocardiogram. The patient had cardiovascular collapse refractory to high-dose vasopressors, necessitating emergent venous-arterial extracorporeal membrane oxygenation for successful resuscitation.