Postoperative respiratory failure due to acute eosinophilic pneumonia.
A non-smoking 63-year-old man developed respiratory failure following surgical repair of a thoracoabdominal aortic aneurysm. He had severe hypoxemia and an elevated minute ventilation requiring prolonged mechanical support. Initial postoperative chest radiographs revealed new, transient, migratory infiltrates, and the patient received broad-spectrum antibiotic therapy. Chest radiographs subsequently demonstrated persistent, diffuse infiltrates, and bronchoalveolar lavage (BAL) analysis demonstrated significant eosinophilia (30%) with no evidence of infection. A diagnosis of acute eosinophilic pneumonia was made, and treatment with intravenous methylprednisolone resulted in rapid clinical improvement, and extubation. Acute eosinophilic pneumonia is not a previously recognized cause of postoperative respiratory failure and prolonged mechanical ventilation. It should be suspected in postoperative patients with unexplained diffuse lung infiltrates and acute respiratory failure.
St John
R C
RC
Department of Internal Medicine, Ohio State University Hospitals, Columbus.
Allen
J N
JN
Pacht
E R
ER
D001012:Aorta, Abdominal; D001013:Aorta, Thoracic; D001014:Aortic Aneurysm / Q000601:surgery*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011657:Pulmonary Eosinophilia / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011859:Radiography; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D015300:Ventilator Weaning
D008775:Methylprednisolone