Dreifuss Stephanie E, Manders Ernest K
School of Medicine, University of Pittsburgh, S532 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, USA.
Case Rep Med. 2013;2013:685716. doi: 10.1155/2013/685716. Epub 2013 Feb 21.
Obstructive sleep apnea (OSA) may occur in association with obesity-hypoventilation (Pickwickian) syndrome, a disorder of ventilatory control affecting individuals with morbid obesity. Through the pressor effects of chronic hypercapnia and hypoxemia, this syndrome may result in pulmonary hypertension, right heart failure, and massive peripheral edema. We present a case of severe scrotal edema in a 36-year-old male with OSA and obesity-hypoventilation syndrome. A tracheostomy was performed to relieve hypoxemia and led to dramatic improvement of scrotal edema. No scrotal surgery was necessary. Followup at two months showed complete resolution of scrotal edema, improvement in mental status, and normalization of arterial blood gas measurements. This case demonstrates that OSA and obesity-hypoventilation syndrome may present with massive scrotal edema. Furthermore, if OSA is recognized as the cause of right heart failure, and if the apnea is corrected, the resultant improvement in cardiac function may allow reversal of massive peripheral, including scrotal, edema.
阻塞性睡眠呼吸暂停（OSA）可能与肥胖低通气（匹克威克氏）综合征相关，这是一种影响病态肥胖个体的通气控制障碍。通过慢性高碳酸血症和低氧血症的升压作用，该综合征可能导致肺动脉高压、右心衰竭和大量外周水肿。我们报告一例36岁患有OSA和肥胖低通气综合征的男性出现严重阴囊水肿的病例。进行气管切开术以缓解低氧血症，并使阴囊水肿显著改善。无需进行阴囊手术。两个月后的随访显示阴囊水肿完全消退、精神状态改善以及动脉血气测量结果正常化。该病例表明，OSA和肥胖低通气综合征可能表现为大量阴囊水肿。此外，如果将OSA识别为右心衰竭的原因，并且如果呼吸暂停得到纠正，由此导致的心脏功能改善可能使包括阴囊水肿在内的大量外周水肿得以消退。
