Department of Anesthesia, St. Vincent's Hospital, Melbourne, 45 Victoria Parade, Fitzroy 3065, Australia.
J Clin Anesth. 2014 Dec;26(8):688-92. doi: 10.1016/j.jclinane.2014.05.011. Epub 2014 Oct 29.
A 65 year old man presented with fever, pancytopenia, hypoxemia, and cardiovascular collapse requiring intensive care unit admission. Computed tomographic pulmonary angiogram showed a right-sided mediastinal mass adjacent to the right atrium. The patient had a video-assisted thoracoscopic surgical biopsy of the mass, with selective bronchial blockade to maximize oxygenation during lung isolation. Intraoperative transesophageal echocardiography showed an unexpected large atrial secundum defect with a right-to-left shunt and intracardiac mass. This shunt could be reversed with a norepinephrine infusion, resulting in improved oxygenation. Histopathology showed potentially curative diffuse large B cell lymphoma (DLBCL).
一位 65 岁男性，以发热、全血细胞减少、低氧血症和心血管衰竭为表现，需要入住重症监护病房。胸部计算机断层扫描肺动脉造影显示右侧纵隔肿块毗邻右心房。患者接受了电视辅助胸腔镜外科活检肿块，并选择性支气管阻断以在隔离肺期间最大化氧合。术中经食管超声心动图显示意料之外的大型房间隔缺损伴右向左分流和心内肿块。这种分流可以通过去甲肾上腺素输注逆转，从而改善氧合。组织病理学显示可能治愈的弥漫性大 B 细胞淋巴瘤（DLBCL）。
