[Respiratory insufficiency and absent left radial pulse after hemicolectomy].
A 65 year old female developed right thoracic pain, productive cough and fever four weeks after hemicolectomy because of a cancer of the sigmoid. In spite of antibiotic treatment the condition of the patient deteriorated and she was admitted to the hospital with pneumonia of an upper lobe. Chest X-ray visualized prominent proximal pulmonary arteries. Progressive respiratory failure developed and blood gas analysis revealed hypocapnic hypoxemia. The patient had to be intubated and ventilated mechanically. Later, left arm blood pressure measurements could no longer be taken and the radial pulse was missing. Thereafter, an ischemic syndrome of the right leg developed. Embolectomy from the superficial femoral artery was carried out the same day. The patient died five days later. Autopsy revealed an almost complete occlusion of the pulmonary arteries. The organization of thrombotic material indicated recurrence. Emboli were also found in the systemic circulation. A large patent foramen ovale together with signs of pulmonary arterial hypertension are indicative of paradoxical thromboembolism.
Streuli
R A
RA
Medizinische Poliklinik, Universität Bern.
Laissue
J A
JA
D000368:Aged; D001132:Arm / Q000098:blood supply*; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D003082:Colectomy; D003937:Diagnosis, Differential; D019320:Embolism, Paradoxical / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000473:pathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000473:pathology; D007511:Ischemia / Q000175:diagnosis* / Q000473:pathology; D007866:Leg / Q000098:blood supply; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology; D011651:Pulmonary Artery / Q000473:pathology; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000473:pathology; D011674:Pulse; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000473:pathology; D012811:Sigmoid Neoplasms / Q000473:pathology / Q000601:surgery*
Respiratorische Insuffizienz und fehlender Radialispuls links nach Hemikolektomie.