title: Cardiovascular collapse and hypoxemia in a man with a right-sided mediastinal mass, undiagnosed atrial septal defect, and right-to-left shunt.
abstract: A 65 year old man presented with fever, pancytopenia, hypoxemia, and cardiovascular collapse requiring intensive care unit admission. Computed tomographic pulmonary angiogram showed a right-sided mediastinal mass adjacent to the right atrium. The patient had a video-assisted thoracoscopic surgical biopsy of the mass, with selective bronchial blockade to maximize oxygenation during lung isolation. Intraoperative transesophageal echocardiography showed an unexpected large atrial secundum defect with a right-to-left shunt and intracardiac mass. This shunt could be reversed with a norepinephrine infusion, resulting in improved oxygenation. Histopathology showed potentially curative diffuse large B cell lymphoma (DLBCL).
authors.affiliation: Department of Anesthesia, St. Vincent's Hospital, Melbourne, 45 Victoria Parade, Fitzroy 3065, Australia. Electronic address: brian.cowie@svhm.org.au.
authors.forename: Brian
authors.initials: B
authors.lastname: Cowie
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D017548:Echocardiography, Transesophageal; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D009638:Norepinephrine / Q000008:administration & dosage; D012769:Shock / Q000209:etiology* / Q000503:physiopathology; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D009638:Norepinephrine
keywords: Echocardiography; Hypoxemia; Lymphoma