Schwartz Stefani M, Greco Katherine J, Reddy Venugopal
Department of Anesthesiology and Perioperative Medicine, Pennsylvania State College of Medicine/ Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Am J Case Rep. 2017 Sep 19;18:1005-1008. doi: 10.12659/ajcr.904946.
BACKGROUND Pulmonary embolism is a common acute postoperative complication and is associated with 100,000 deaths per year in the USA. Tracheobronchomalacia is an uncommon condition, which presents with similar symptoms to pulmonary embolism, including hypoxemia, tachycardia, and shortness of breath. We describe a case of a patient who presented with postoperative pulmonary symptoms that were initially thought to be due to pulmonary embolism. However, following imaging investigations these symptoms were found to be due to tracheobronchomalacia. CASE REPORT A 73-year-old woman underwent elective ventral hernia repair and takedown of a Hartmann's pouch. On the ninth postoperative day, she developed symptoms of acute respiratory distress and was admitted to the surgical intensive care unit. Respiratory function tests and blood gas evaluation showed that her alveolar-arterial oxygen gradient (A-a gradient) and modified Wells' score were suggestive of a diagnosis of pulmonary embolism. A contrast-enhanced computed tomography (CT) scan of the lungs was negative for pulmonary embolism but demonstrated findings suggestive of tracheobronchomalacia. CONCLUSIONS Tracheobronchomalacia should be considered in the differential diagnosis of hypoxia when evaluating a patient in the ICU.
肺栓塞是一种常见的术后急性并发症，在美国每年导致10万人死亡。气管支气管软化是一种罕见疾病，其症状与肺栓塞相似，包括低氧血症、心动过速和呼吸急促。我们描述了一例患者，其术后出现肺部症状，最初认为是由肺栓塞引起的。然而，经过影像学检查，发现这些症状是由气管支气管软化所致。病例报告：一名73岁女性接受了择期腹疝修补术并拆除了哈特曼袋。术后第9天，她出现急性呼吸窘迫症状，被收入外科重症监护病房。呼吸功能测试和血气评估显示，她的肺泡-动脉氧梯度（A-a梯度）和改良Wells评分提示肺栓塞诊断。肺部增强计算机断层扫描（CT）显示肺栓塞阴性，但有提示气管支气管软化的表现。结论：在评估重症监护病房患者的缺氧鉴别诊断时，应考虑气管支气管软化。
