Flow phenomenon, a differential diagnosis in refractory hypoxaemia in patients with anterior mediastinal mass. Case report
Abstract
Introduction: Refractory hypoxaemia is a critical, life-threatening condition if not resolved promptly. The flow phenomenon is implicated in its development.
Objectives:Clinical case presentation and non-systematic review of the literature on refractory hypoxaemia and flow phenomenon. Incidence, aetiology and pathophysiology are described.
Materials and methods: Clinical case presentation authorised by the Ethics Committee of our institution of a young patient who presented with progressive dyspnoea, reaching functional class IV/IV. A search of the literature was conducted in Pub Med, Scielo and Bireme.
Results: There is a growing interest in the physiological flow phenomenon leading to the development of refractory hypoxaemia in the absence of increased pressure in the cardiac cavities. Few reports are found.
Conclusions: Flow phenomenon-related refractory hypoxaemia must be suspected as an exclusion diagnosis in patients with a mediastinal mass. Prone ventilation is proposed as a bridging therapy in order to revert a life-threatening condition.
References
2. Rodriguez-Roisin R, Roca J. Mechanisms of hypoxemia. Intensive Care Med. 2005;31:1017-9.
3. Williams AJ. ABC of oxygen: assessing and interpreting arterial blood gases and acid-base balance. BMJ. 1998;317:1213-6.
4. Hansen JE. Arterial blood gases. Clin Chest Med. 1989;10:227-37.
5. Seeger W, Adir Y, Barberá JA, Champion H, Coghlan JG, Cottin V, et al. Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol. 2013;62 Suppl.:D109-16.
6. Mueller-Mang C, Grosse C, Schmid K, Stiebellehner L, Bankier AA. What every radiologist should know about idiopathic interstitial pneumonias. Radiographics. 2007;27:595-615.
7. Santolicandro A, Prediletto R, Fornai E, Formichi B, Begliomini E, Giannella-Neto A, et al. Mechanisms of hypoxemia and hypocapnia in pulmonary embolism. Am J Respir Crit Care Med. 1995;152:336-47.
8. Young IH, Bye PT. Gas exchange in disease: asthma, chronic obstructive pulmonary disease, cystic fibrosis, and interstitial lung disease. Compr Physiol. 2011;1:663-97.
9. Godart F, Rey C, Prat A, Vincentelli A, Chma'it A, Francart C, et al. Atrial right-to-left shunting causing severe hypoxaemia despite normal right-sided pressures. Report of 11 consecutive cases corrected by percutaneous closure. Eur Heart J. 2000;21:483-9.
10. Zanchetta M, Rigatelli G, Ho SY. A mystery featuring right-to-left shunting despite normal intracardiac pressure. Chest. 2005;128:998-1002.
11. Offin MD, Menachem J, Squillante C, Ky B, Vaughn D, Carver J. Association among hypoxemia, patent foramen ovale, and mediastinal germ cell tumor: a case report. Ann Intern Med. 2015;163:243-4.
12. Cowie B. Cardiovascular collapse and hypoxemia in a man with a right-sided mediastinal mass, undiagnosed atrial septal defect, and right-to-left shunt. J Clin Anesth. 2014;26:688-92.
13. Albert RK. Prone ventilation. Clin Chest Med. 2000;21:511-7.
14. Albert RK, Hubmayr RD The prone position eliminates compression of the lungs by the heart. Am J Respir Crit Care Med. 2000;161:1660-5.
15. Santos CL, dos Santos Samary C, Fiorio Júnior PL, Lourenco Santos B, Schanaider A. Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy? Rev Col Bras Cir. 2015;42:125-9.
16. Mehta C, Mehta Y. Management of refractory hypoxemia. Ann Card Anaesth. 2016;19:89-96.
17. Takeda S, Miyoshi S, Omori K, Okumura M, Matsuda H. Surgical rescue for life-threatening hypoxemia caused by a mediastinal tumor. Ann Thorac Surg. 1999;68:2324-6.
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