Œdème aigu du poumon par obstruction des voies aériennes et tamponnade cardiaque en relation avec une tumeur médiastinale

• Published in: Annales françaises d'anesthésie et de réanimation Vol. 7; no. 6; pp. 506 - 508
• Main Authors: Pascual, P. Rubio, Bermejo, P. Martin, Alvarez, J. Abades
• Format: Journal Article
• Language: French
• Published: Paris Elsevier SAS 1988; Elsevier
• Subjects: Anesthesie. Reanimation. Transfusion. Therapie cellulaire et therapie genique; Anesthésie; Anesthésie selon le type d'intervention; Chirurgie thoracique et cardiovasculaire. Circulation extracorporelle; Sciences biologiques et medicales; Sciences medicales; Système cardiovasculaire : cœur, péricarde; Système respiratoire : poumon, œdème aigu, bronches, obstruction; Système cardiovasculaire : cœur, péricarde; Système respiratoire : poumon, œdème aigu, bronches, obstruction; Poumon; Bronche; Homme; Médiastin; Chirurgie; Aigu; Anesthésie générale; Appareil respiratoire pathologie; Complication; Tumeur; Obstruction; Oedème
• ISSN: 0750-7658; 1769-6623
• DOI: 10.1016/S0750-7658(88)80089-3

Ce travail rapporte et discute le cas d'une patiente atteinte d'un processus tumoral médiastinal, responsable d'une obstruction aiguë des voies aériennes et d'un œdème aigu du poumon d'étiologie mixte, cardiogénique et non cardiogénique. A case is reported of acute airway obstruction and pulmonary oedema of mixed origin (cardiogenic and non cardiogenic), occurring in a patient after surgical treatment for pericardial tamponade due to a mediastinal tumour. This 45 year old female patient had a non-Hodgkin lymphoma, mostly located within the anterior and middle mediastinum. When she developped cardiac tamponade, emergency cardiac decompression was carried out. The surgical procedure went well, despite an episode of severe hypotension. Immediately after extubation, she developed paradoxical breathing with retraction and cyanosis. She was reintubated and ventilated. The chest X-ray showed bilateral alveolar infiltrates, mostly around the hila. Two hours later, she was again extubated and developed again the same respiratory failure. This time, she was intubated and ventilated for 48 h. She was then extubated with no problem. It seemed most probable that transmission to the interstitial space of a negative intrapleural pressure due to the inspiratory efforts made against an occluded airway was the principal mechanism responsible for the accumulation of fluid to this space.