title: The rendu-osler-weber disease revealed by a refractory hypoxemia and severe cerebral fat embolism.
abstract: The Rendu-Osler-Weber disease is a genetic disease which may lead to severe hemorrhage and less frequently to severe organ dysfunction. We report the case of a 22-year-old patient with no personal medical history who was involved in a motorcycle accident and exhibited severe complications related to large arteriovenous pulmonary shunts during his ICU stay. The patient developed an unexplained severe hypoxemia which was attributed to several arteriovenous shunts of the pulmonary vasculature by a contrast study during a transesophageal echocardiographic examination. The course was subsequently complicated by a prolonged coma associated with hemiplegia which was attributed to a massive paradoxical fat embolism in the setting of an untreated femoral fracture. In addition to hemorrhagic complications which may lead to intractable shock, arteriovenous malformations associated with the Rendu-Osler-Weber disease may involve the pulmonary vasculature and result in unexpected complications, such as hypoxemia or severe cerebral fat embolism in high-risk patients.
authors.affiliation: Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000 Limoges, France.
authors.forename: Leonel
authors.initials: L
authors.lastname: Barreto
authors.affiliation: Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000 Limoges, France ; CIC-P 0801, Dupuytren Teaching Hospital, 87000 Limoges, France.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Amiel
authors.affiliation: Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000 Limoges, France ; CIC-P 0801, Dupuytren Teaching Hospital, 87000 Limoges, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Dugard
authors.affiliation: Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000 Limoges, France ; CIC-P 0801, Dupuytren Teaching Hospital, 87000 Limoges, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pichon
authors.affiliation: Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000 Limoges, France ; CIC-P 0801, Dupuytren Teaching Hospital, 87000 Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Clavel
authors.affiliation: Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000 Limoges, France ; CIC-P 0801, Dupuytren Teaching Hospital, 87000 Limoges, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.affiliation: Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000 Limoges, France ; CIC-P 0801, Dupuytren Teaching Hospital, 87000 Limoges, France ; University of Limoges, 87000 Limoges, France ; Service de Réanimation Polyvalente, CHU Dupuytren, 2 Avenue Martin Luther King, 87042 Limoges Cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon