title: [Case of lymphangioleiomyomatosis (LAM) discovered during cesarean section under spinal anesthesia].
abstract: We experienced a case of scheduled cesarean section under spinal anesthesia in a patient with LAM which had been missed in spite of preoperative medical examination and consultation with specialists but discovered because of perioperative hypoxia A 35-year-old woman, Gravida 1 Para 0, with breech presentation was scheduled to undergo cesarean section under spinal anesthesia at 38 weeks of gestation. She had no history of asthma or abnormal findings at annual medical examination. She had suffered from dry cough and nocturnal dyspnea for 7 weeks and an inhaled bronchodilator was administered with diagnosis of inflammatory airway disease by her respiratory physicians. Spinal anesthesia was performed with bupivacaine 12.5 mg. At the beginning of anesthesia SPO2 was 97% in supine position, but it rapidly decreased to less than 90% and 3 l x min(-1) oxygen was supplied with a facial mask. The anesthetic level was thoracal 4 bilaterally and her breathing was stable. The circulatory state, Apgar score and other vital signs were within normal ranges. Postoperative chest X-ray showed bilateral numerous grained spots and computed tomography scans showed multiple thin-walled cysts. The characteristic history and the fluoroscopic data gave her clinical diagnosis of LAM.
authors.affiliation: Department of Anesthesiology, Hoshigaoka Kouseinenkin Hospital, Hirakata 573-8511.
authors.forename: Mika
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Department of Anesthesiology, Hoshigaoka Kouseinenkin Hospital, Hirakata 573-8511.
authors.forename: Nahomi
authors.initials: N
authors.lastname: Okura
authors.affiliation: Department of Anesthesiology, Hoshigaoka Kouseinenkin Hospital, Hirakata 573-8511.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kashii
authors.affiliation: Department of Anesthesiology, Hoshigaoka Kouseinenkin Hospital, Hirakata 573-8511.
authors.forename: Mitsuji
authors.initials: M
authors.lastname: Matsushita
authors.affiliation: Department of Anesthesiology, Hoshigaoka Kouseinenkin Hospital, Hirakata 573-8511.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Obstetrics and Gynecology, Hoshigaoka Kouseinenkin Hospital, Hirakata 573-8511.
authors.forename: Masayo
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Anesthesiology, Hoshigaoka Kouseinenkin Hospital, Hirakata 573-8511.
authors.forename: Shigehisa
authors.initials: S
authors.lastname: Tsujimura
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D002045:Bupivacaine; D002585:Cesarean Section; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007431:Intraoperative Complications / Q000209:etiology; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008203:Lymphangiomyoma / Q000150:complications / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D002045:Bupivacaine