[Case report of re-expansion pulmonary edema in a patient with anorexia nervosa after removal of a huge ovarian tumor].
We described a case of 19-year-old female who developed re-expansion pulmonary edema (RPE) after removal of a huge ovarian tumor. Altered lung volume after the surgery was observed by chest X-ray. Preoperatively, the lung was highly compressed by the tumor. Patient was intubated under general anesthesia and was ventilated by pressure controlled mode with only 5 cmH2O of positive end-expiratory pressure (PEEP). P/F ratio was changed from 163 to 444 after removal of the tumor. At the end of the surgery, P/F ratio decreased to 263 with yellow frothy sputum in the endotracheal tube and we diagnosed re-expansion pulmonary edema based on appearing yellow frothy sputum and chest X-ray. No recruitment procedure was carried out through the course except positive pressure ventilation with 5 cmH2O of PEEP in the intensive care unit after surgery. Twelve hours after the surgery, we could not confirm the recovery of lung volume on chest X-ray; however the patient was extubated because of P/F ratio increasing to 507. After 8 days of the surgery, the chest X-ray showed recovery of the lung volume to almost normal size. In this case, the compressed lung needed almost 1 week to recover the lung volume. This change in chest X-ray might indicate inadequate recovery of lung volume by recruitment maneuver and this should be avoided in order not to allow development of unfavorable clinical course of RPE.
Junko
J
Hari
Masayasu
M
Arai
Yasuharu
Y
Kosaka
Masaya
M
Toda
Masayuki
M
Kuroiwa
Hirotsugu
H
Okamoto
D000293:Adolescent; D000758:Anesthesia; D000856:Anorexia Nervosa / Q000150:complications*; D000075202:Contraindications; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000150:complications* / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D013902:Radiography, Thoracic; D012559:Schizophrenia / Q000150:complications; D016896:Treatment Outcome