Tan Geak Poh, Abisheganaden John Arputhan, Goh Soon Keng, Verma Akash
Department of Respiratory and Critical Care Medicine Tan Tock Seng Hospital Singapore.
Respirol Case Rep. 2018 Feb 7;6(3):e00303. doi: 10.1002/rcr2.303. eCollection 2018 Apr.
Bronchial stenosis is known to complicate endobronchial tuberculosis despite medical therapy. It is often associated with dyspnoea. In severe cases, bronchial stenosis results in airflow obstruction, impaired secretion clearance, and can lead to respiratory failure. We present an unusual observation of platypnoea-orthodeoxia syndrome in a young woman with acute atelectasis due to post-tuberculosis bronchial stricture. Imaging revealed complete middle and right lower lobe atelectasis with a partially aerated right upper lobe. In the sitting posture, there was positional worsening of dyspnoea associated with an increase in the alveolar-arterial oxygen gradient and shunt fraction. The likely mechanism was due to gravitational difference in ventilation-perfusion matching. The platypnoea-orthodeoxia syndrome was reversible following balloon dilatation of the bronchial stenosis and expansion of the collapsed lung.
尽管接受了药物治疗，但支气管狭窄仍是支气管内膜结核的常见并发症。它常与呼吸困难相关。在严重情况下，支气管狭窄会导致气流阻塞、分泌物清除受损，并可能导致呼吸衰竭。我们报告了一例年轻女性因结核后支气管狭窄导致急性肺不张而出现平卧呼吸-直立性低氧血症综合征的罕见病例。影像学检查显示中肺和右下肺完全肺不张，右上肺部分充气。在坐位时，呼吸困难会因肺泡-动脉氧梯度和分流分数增加而加重。可能的机制是由于通气-灌注匹配的重力差异。支气管狭窄球囊扩张和萎陷肺复张后，平卧呼吸-直立性低氧血症综合征可逆转。
