Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 1514, Toronto, ON M5G 1X5, Canada.
Can J Anaesth. 2011 Mar;58(3):285-9. doi: 10.1007/s12630-010-9431-0. Epub 2010 Dec 4.
To report the management of a Cesarean delivery complicated by postpartum pulmonary edema in a parturient with a large mediastinal mass.
A patient with an anterior mediastinal mass presented to the labour and delivery floor at 37 weeks of gestation with cough, severe dyspnea, and chest pain. Radiological investigations revealed that the mass occupied mainly the right side of the thorax and produced compression of the mediastinal structures. The patient underwent an elective Cesarean delivery under epidural anesthesia; however, immediately following the placental delivery, she developed unilateral pulmonary edema. She was managed successfully with diuretics, and her subsequent course in the hospital was uneventful. The biopsy of the mass revealed a lymphoma, which was treated eventually by chemotherapy. Both the mother and her baby are doing well after two years of follow-up.
A multidisciplinary approach should be considered in the management of a pregnant patient with symptomatic anterior mediastinal mass. Practitioners should be aware of the possibility of unilateral pulmonary edema in patients with an anterior mediastinal mass compressing pulmonary veins. Such patients should be treated promptly with diuretics to prevent further adverse outcomes.
报告一例因纵隔大肿块导致剖宫产术后并发产后肺水肿的产妇的处理方法。
一位前纵隔肿块患者在妊娠 37 周时因咳嗽、严重呼吸困难和胸痛就诊于产房。影像学检查显示肿块主要占据右侧胸腔并压迫纵隔结构。患者在硬膜外麻醉下接受了选择性剖宫产术；然而，胎盘娩出后，她立即出现单侧肺水肿。她成功地接受了利尿剂治疗，随后在医院的病程中无并发症。肿块的活检显示为淋巴瘤，最终通过化疗进行治疗。两年随访后，母亲和婴儿情况良好。
对于有症状的前纵隔肿块的孕妇，应考虑采用多学科方法进行治疗。医生应意识到前纵隔肿块压迫肺静脉可能导致单侧肺水肿。对于此类患者，应及时使用利尿剂进行治疗，以防止出现进一步的不良后果。
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