Cardiology, Aster MIMS Hospital, Kannur, Kerala, India.
Cardiology, Aster MIMS Hospital, Kannur, Kerala, India
BMJ Case Rep. 2024 Aug 29;17(8):e256335. doi: 10.1136/bcr-2023-256335.
A middle-aged man presented with inferior wall ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention with tirofiban administered due to extensive thrombus. He developed sudden-onset dyspnoea, bilateral crepitations, haemoptysis, desaturation and hypotension an hour after starting tirofiban infusion. The tirofiban, antiplatelet medications and heparin were stopped immediately. Chest X-ray showed patchy opacities in the left upper, middle and lower zones. High-resolution CT showed confluent areas of consolidation with surrounding ground glass opacities and interlobular septal thickening (crazy pavement appearance) representing diffuse alveolar haemorrhage (DAH). He was managed with inotropes, non-invasive ventilation and intravenous furosemide. He was asymptomatic with complete resolution of lung opacities in chest X-ray done 2 months follow-up. DAH is a rare but potentially life-threatening complication which is often misidentified with other respiratory syndromes. Treatment includes stopping tirofiban and anticoagulant medication, blood transfusion, and institution of mechanical ventilation.
一名中年男性因广泛血栓形成，接受了替罗非班的初级经皮冠状动脉介入治疗，出现下壁 ST 段抬高型心肌梗死。替罗非班输注开始后 1 小时，他突然出现呼吸困难、双侧爆裂音、咯血、血氧饱和度下降和低血压。立即停止替罗非班、抗血小板药物和肝素。胸部 X 线片显示左肺上、中、下区斑片状阴影。高分辨率 CT 显示融合性实变区伴周围磨玻璃影和小叶间隔增厚（疯狂铺路石外观），代表弥漫性肺泡出血（DAH）。他接受了正性肌力药物、无创通气和静脉注射呋塞米治疗。2 个月随访时，他的胸部 X 线检查显示肺部阴影完全吸收，症状已完全缓解。DAH 是一种罕见但潜在危及生命的并发症，常与其他呼吸系统综合征混淆。治疗包括停止替罗非班和抗凝药物、输血以及机械通气。
