Liet J M, Moreau A, Ardouin T, Dahl K, Roze J C
Service de réanimation pédiatrique, CHRU de Nantes, France.
Arch Pediatr. 1997 Jun;4(6):547-9. doi: 10.1016/s0929-693x(97)87577-x.
Acute respiratory distress occurring in a child without any past medical history can have different origins. Pulmonary edema can be lesional or hemodynamic in origin. Bronchoalveolar lavage often allows indication of the type of lesional oedema.
A 13-year old child was hospitalized for acute respiratory distress 24 hours after knee surgery complicated by a fracture of the tibial metaphysis. There were no clinical manifestations of airway obstruction. Chest X-ray showed pulmonary parenchymous pathology. Pulmonary edema secondary to congestive heart failure was eliminated by doppler echocardiogram. The cause of lesional pulmonary edema was found with bronchoalveolar lavage that showed fat drops in the cytoplasm of many alveolar macrophages.
Fat embolism syndrome may be confirmed by examination of bronchoalveolar lavage fluid.
既往无病史的儿童出现急性呼吸窘迫可能有不同病因。肺水肿可能源于病变或血流动力学因素。支气管肺泡灌洗通常有助于明确病变性水肿的类型。
一名13岁儿童在膝关节手术后24小时因急性呼吸窘迫入院，该手术并发胫骨近端干骺端骨折。无气道阻塞的临床表现。胸部X线显示肺实质病变。经多普勒超声心动图排除了充血性心力衰竭继发的肺水肿。通过支气管肺泡灌洗发现了病变性肺水肿的病因，灌洗显示许多肺泡巨噬细胞的细胞质中有脂肪滴。
通过检查支气管肺泡灌洗液可确诊脂肪栓塞综合征。
