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Desaturating Patient with Long Bone Fractures
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Devendra Kumar Chouhan, Narendra Chouhan
Detection of fat droplets in sputum, urine and blood. Arterial blood gas analysis shows hypoxia, with a PaO2 of less than 60 mmHg along with the presence of hypocapnia. An increase in pulmonary shunt fraction and an alveolar-to-arterial oxygen tension difference, especially within 24–48 h of an event, is suggestive of the diagnosis.
Waterfall Hilum
Published in Michael E. Mulligan, Classic Radiologic Signs, 2020
Larry Elliott and Gerold Schiebler1 (then at University of Florida) in their book, The X-ray Diagnosis of Congenital Heart Disease in Infants, Children, and Adults, ascribe this distinct sign of pulmonary shunt vascularity (Figure 1) to Kent Ellis. Shunt vascularity is another one of the key findings to look for when evaluating the chest radiograph in cases of congenital heart disease (see Egg shaped heart, Mogul shadow and Shmoo shaped heart). In the book, Elliott reported that the most common congenital heart condition prone to show the ‘waterfall right hilum’ sign is transposition of the great vessels with a single ventricle.1 ‘The other complex lesions [transposition, tricuspid atresia, truncus arteriosus], most notably complete transposition with a large [ventricular septal defect] VSD, may uncommonly show the same finding … the so-called ‘waterfall right hilum’ sign. It is produced by the combination of torrential and increased pulmonary flow plus an elevation of the right pulmonary artery (RPA) itself. The elevation of the RPA is caused by massive dilatation of the pulmonary trunk, which, in turn, causes an uplifting of the RPA.’1
Drowning
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
Hypotonic liquid that is partially absorbed into the pulmonary circulation damages pulmonary surfactant, increases alveolar surface tension and reduces pulmonary compliance. The resultant atelectasis alters ventilation-to-perfusion ratios: blood perfusion occurs in non-ventilated areas and venous blood bypasses the lungs. Up to 70 per cent of the cardiac output may be shunted past perfused but unventilated alveoli. Hypertonic media draw liquid from the plasma into the alveoli, which also results in damage to the surfactant. One estimate is that 2.5 ml/kg of seawater may cause the pulmonary shunt fraction to increase by 75 per cent, and that as little as 1–3 ml/kg may reduce pulmonary compliance by 10 per cent to 40 per cent [48,80,99,100].
Tetralogy of Fallot with isolated levocardia in a young female
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Zeeshan Sattar, Hafez Muhammad Abdullah, Sohaib Roomi, Waqas Ullah, Adnan Khan, Ali Ghani, Asrar Ahmad
Surgical correction is advised for all patients with TOF. Even though some patients with uncorrected TOF can live long lives, surgical correction has consistently shown to improve survival [14]. Initially a two-step procedure used to be performed with an initial systemic-to-pulmonary shunt for palliation and a later complete repair that involved closure of the VSD and correction of the outflow tract obstruction. However, since the advent of cardiopulmonary bypass and cardioplegia, a single step procedure is now recommended and at an earlier age [15]. Asymptomatic patients are now recommended to undergo correction at 3–6 months of age and severely symptomatic patients should undergo correction even earlier than that [10,16]. Our patient was known to have a cyanotic heart disease but could not undergo surgical correction early in her life because of a lack of access to medical facilities. However, when her shortness of breath and cyanotic episodes became unbearable, her family shifted her to Pakistan for medical treatment.
Congenital heart disease: addressing the need for novel lower-risk percutaneous interventional strategies
Published in Expert Review of Cardiovascular Therapy, 2023
N Linnane, DP Kenny, ZM Hijazi
For a large number of patients, their initial intervention will be palliative to bridge them to a weight and age, suitable for definitive care. Long-term prostaglandin infusion has been reported to be safe with limited side effects [33] but patients require long-term intravenous access and must remain in hospital. In the past, a systemic-to-pulmonary shunt (SPS) was the procedure of choice for palliation, until definitive repair. However, with a 30-day mortality of at least 6.5% in the current era [34], despite over six decades of experience, an SPS is not demonstrating progressive reduction in mortality, similar to other surgical techniques. Thus, newer lower-risk interventional strategies are required for these complex patients.
Eisenmenger syndrome and other types of pulmonary arterial hypertension related to adult congenital heart disease
Published in Expert Review of Cardiovascular Therapy, 2019
Carla Favoccia, Andrew H Constantine, Stephen J Wort, Konstantinos Dimopoulos
The chest radiograph is also helpful in detecting the pulmonary vascular pattern. Pulmonary venous congestion is indicated by prominent upper lobe vessels in patients with left heart disease. Increased vascularity is suggestive of pulmonary plethora, as is seen in patients with a significant systemic-to-pulmonary shunt. Pleural effusions or consolidation, as in the presence of a lower respiratory tract infection or haemoptysis, can also be seen. Other useful information derived from the chest radiograph includes signs of prior surgery, thoracic skeletal abnormalities (e.g. scoliosis), parenchymal lung disease (e.g. lung fibrosis, bronchopulmonary dysplasia), which may prompt further investigations.