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Vertebral Erosion: An Uncommon Complication of Tracheal Tubes Irina Petrache, Damien Patel, Karen M. Wolf, and Helen Winer-Muram Departments of Medicine and Radiology, Indiana University, Indianapolis, Indiana; and 2Richard L. Roudebush VA Medical Center, Indianapolis, Indiana Am J Respir Crit Care Med 2014; 190: e4 一名40岁男性患者罹患系统性红斑狼疮及曲霉菌病合并呼吸功能衰竭,其带有套囊的10号Shiley气管切开管周围间断漏气。胸部CT显示气管切开管套囊压迫导致颈椎侵蚀(图1A-1C...
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Pulmonary Arterial Mycotic Pseudoaneurysms in a Patient with Invasive Pulmonary Aspergillosis: Successful Occlusion by Coils Morgane Didier, Pierre Guedin, Fabrice Staub, Emilie Catherinot, Elisabeth Rivaud, Antoine Scherrer, Colas Tcherakian, and Louis-Jean Couderc Am J Respir Crit Care Med Vol 190, Iss 1, pp 112–113, Jul 1, 2014 图1. (A)栓塞前增强CT冠状位纵隔窗显示3个霉菌性动脉瘤(箭头所示),最大者直径15 mm,滋养血管均为肺动脉:左上叶尖段的两个分支以及右上叶尖背段。(B)...
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A Right Heart Catheterization with a Puzzling Pathway Karim El-Kersh, J. Shaun Smith Department of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, Kentucky Am J Respir Crit Care Med Vol 189, Iss 10, pp 1275–1276, May 15, 2014   图1 透视显示Swan-Ganz导管(经右股静脉置入)越过中线,从左侧下腔静脉经半奇静脉(HAz)上行,然后经左侧上腔静脉(SVC)下行,终止于肺动脉(PA)。右心房(RA)、右心室(RV)和肺动脉压力均在正常范围,且无分流迹象。 ...
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Pulmonary Tuberculosis Presenting as Organizing Pneumonia Min-Han Hsieh, Chun-Yu Lin Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and 2Graduate Institute of Medicine, Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Am J Respir Crit Care Med Vol 189, Iss 9, p e63, May 1, 2014   一名无HIV感染的80岁男性患者...
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Imaging in Intensive Care Medicine Dedicated NAVA enteral feeding tube placement complicated by a hydropneumothorax but producing a correct EAdi signal G. van Kerckhoven and K. M. Kant Intensive Care Medicine2015:3981 DOI: 10.1007/s00134-015-3981-0   一名77岁女性患者发生院内心跳骤停后转入ICU。尽管患者神经系统恢复良好,但在ICU期间出现脱机困难。我们选择了一种心的辅助机械通气模式即神经调节通气辅助(NAVA)以加速脱机进程。 A 77-year-old female who experienced an in-hos...
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Image in Intensive Care Medicine Pathergy phenomenon: huge pyoderma gangrenosum following tube thoracostomy Yu-Tzu Tsao, Wei-Liang Chen, Jui-Chang Chen Intensive Care Med (2014) 40:1935 DOI 10.1007/s00134-014-3436-z 一名37岁男性患者因右侧自发性气胸接受治疗。进行右侧胸腔置管后右肺完全复张。但是,置管部位周围组织开始出现坏死且极度疼痛,2周内发展为面积很大的深溃疡(图1)。实验室检查无异常,微生物学检查结果均为阴性。皮肤活检提示嗜中性粒细胞性皮肤病(neutrophilic dermatosis),病...
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中心静脉导管误入肺静脉:引起癫痫发作的罕见病因 Central venous catheter malposition into pulmonary vein: an unusual cause of epileptic seizures Miguel A. Hernández-Hernández JoséL. Fernández-Torre María S. Holanda-Peña Marta Cabello Intensive Care Med DOI 10.1007/s00134-015-3940-9 一名64岁男性患者因急性呼吸功能衰竭收入ICU。为避免患者平卧,医生留置了60 cm的股静脉导管(CVC)。胸片显示右下肺不张,但是并未注意导管尖端位置是否正确。24小时后,患者发生癫痫,遂进行头颅CT血管造影。经...
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Reverse triggering in a patient with ARDS Hodane Yonis Florent Gobert Romain Tapponnier Claude Guerin Intensive Care Med DOI 10.1007/s00134-015-3702-8 A 50-year-old obese (BMI 51 kg/m2) woman was intubated on October 25, 2014 for acute respiratory distress syndrome due to septic shock from skin and soft tissues infection of the left leg. Because PaO2/FIO2 was 117 mmHg on PEEP, 13 cm H2O and FIO2 0.60, she was placed in the prone position for 16 h under continuous i.v. seda...
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IMAGES IN CLINICAL MEDICINE Trapped Lung Jeffrey Albores, M.D., and Tisha Wang, M.D. N Engl J Med 2015; 372:e25 May 7, 2015 DOI: 10.1056/NEJMicm1404964 一名46岁终末期肝病的女性患者出现复发性肝性胸水(recurrent hepatic hydrothorax)需要反复胸腔穿刺。患者因呼吸困难就诊。胸部检查发现右肺无呼吸音。胸片显示液气胸(图A,箭头显示气胸,星号显示液胸)。遂留置猪尾导管引流胸腔积液,但气胸仍持续存在(图B,箭头)。胸部CT扫描发现肺萎陷(trapped lung, pneumothorax ex vacuo)伴脏层胸膜增厚,...
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IMAGES IN CLINICAL MEDICINE Loss of Fingerprints Yanin Chavarri-Guerra, M.D., and Enrique Soto-Perez-de-Celis, M.D. N Engl J Med 2015; 372:e22April 16, 2015 DOI: 10.1056/NEJMicm1409635 一名65岁女性IV期乳腺癌患者因为银行无法识别指纹(图A)而拒绝进行转账就诊。在过去3个月内,患者因三阴性乳腺癌(指雌激素受体、孕激素受体及人表皮生长因子受体2型[HER2]表达缺乏的肿瘤)接受卡培他滨(希罗达,capecitabine)和贝伐单抗(阿瓦斯汀,bevacizumab)治疗。在第一疗程中,患者发生了1度手足综合征...
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