Postoperative hypoxia in a woman with Down's syndrome: case progressio
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《英国医生杂志》
1 Northern General Hospital, Sheffield S5 7AU, 2 Ninewells Hospital, Dundee DD1 95Y, 3 Rotherham District General Hospital, Rotherham S60 2UD
Correspondence to: A K Siotia Anjan.Siotia@sth.nhs.uk
Last week (9 April, p 834) we presented the case of Miss Webb, who has Down's syndrome and had a sudden postoperative deterioration in her condition after a hysterectomy for menorrhagia. We invited readers to comment on the ethical issues around surgery and the possible cause and management of her postoperative hypoxia.
Miss Webb's chest radiograph
Results of laboratory analysis of pericardial fluid
Questions
What further investigations would you do?
What is the likely diagnosis?
How would you treat this patient?
Please respond through bmj.com, remembering that Miss Webb is a real patient and that she and her carers will read your response
We suspected a pulmonary embolism but her V/Q scan showed no abnormality. She then had echocardiography to investigate unexplained hypoxia and possible cardiomegaly seen in the chest radiograph. This showed a large pericardial effusion with a normal cardiac anatomy and function. A pericardial drain was inserted, and 1100 ml of straw coloured fluid was drained. The table gives the results of laboratory analysis of the aspirate. She made good progress immediately after the drainage of pericardial fluid and her oxygen saturation returned to normal. She was transferred to a medical ward after three days in the intensive therapy unit. One week later, repeat echocardiography showed only trivial pericardial effusion. She was discharged from hospital with a diagnosis of pericardial effusion of unknown cause.
One month later, she was readmitted to the hospital with gradually worsening shortness of breath, cyanosis, and one episode of loss of consciousness lasting for a few seconds. Clinically she looked very unwell. The figure shows her chest radiograph. Echocardiography showed the recurrence of a large pericardial effusion.
This is the second of a three part case report where we invite readers to take part in considering the diagnosis and management of a real patient using the rapid response feature on bmj.com. In three weeks' time we will report the outcome and summarise the responses
Competing interests: None declared.
Related Article
Postoperative hypoxia in a woman with Down's syndrome: case presentation
A K Siotia, A Chaudhuri, S I Muzulu, D Harling, and R Muthusamy
BMJ 2005 330: 834.(A K Siotia, research fellow in cardiolog)
Correspondence to: A K Siotia Anjan.Siotia@sth.nhs.uk
Last week (9 April, p 834) we presented the case of Miss Webb, who has Down's syndrome and had a sudden postoperative deterioration in her condition after a hysterectomy for menorrhagia. We invited readers to comment on the ethical issues around surgery and the possible cause and management of her postoperative hypoxia.
Miss Webb's chest radiograph
Results of laboratory analysis of pericardial fluid
Questions
What further investigations would you do?
What is the likely diagnosis?
How would you treat this patient?
Please respond through bmj.com, remembering that Miss Webb is a real patient and that she and her carers will read your response
We suspected a pulmonary embolism but her V/Q scan showed no abnormality. She then had echocardiography to investigate unexplained hypoxia and possible cardiomegaly seen in the chest radiograph. This showed a large pericardial effusion with a normal cardiac anatomy and function. A pericardial drain was inserted, and 1100 ml of straw coloured fluid was drained. The table gives the results of laboratory analysis of the aspirate. She made good progress immediately after the drainage of pericardial fluid and her oxygen saturation returned to normal. She was transferred to a medical ward after three days in the intensive therapy unit. One week later, repeat echocardiography showed only trivial pericardial effusion. She was discharged from hospital with a diagnosis of pericardial effusion of unknown cause.
One month later, she was readmitted to the hospital with gradually worsening shortness of breath, cyanosis, and one episode of loss of consciousness lasting for a few seconds. Clinically she looked very unwell. The figure shows her chest radiograph. Echocardiography showed the recurrence of a large pericardial effusion.
This is the second of a three part case report where we invite readers to take part in considering the diagnosis and management of a real patient using the rapid response feature on bmj.com. In three weeks' time we will report the outcome and summarise the responses
Competing interests: None declared.
Related Article
Postoperative hypoxia in a woman with Down's syndrome: case presentation
A K Siotia, A Chaudhuri, S I Muzulu, D Harling, and R Muthusamy
BMJ 2005 330: 834.(A K Siotia, research fellow in cardiolog)