ABSTRACT
INTRODUCTION: Acute lung injuries are usually found in intensive care unit. The diffuse alveolar damage (DAD) is the associated histological pattern and the most severe end-stage of the disease. Organizing pneumonia (OP), for which corticosteroids are the reference therapy, can mimic DAD. While postponing the response to treatment, to limit mechanical ventilation side effects, extracorporeal membrane oxygene can be proposed. We present a case of a severe OP for which extracorporeal CO2 removal (ECCO2R) is used as a bridge to recovery under corticosteroid therapy. CASE REPORT: In the context of a flu-like syndrome, the non-recovery of a lung impairment is reported to a severe OP. ECCO2R is applied when using an ultraprotective ventilation and while waiting for lung healing under corticosteroid. This strategy allowed successful recovery, early physical therapy and active mobilization. CONCLUSION: This observation presents the diagnostic and therapeutic difficulties of the lung parenchymental disease in intensive care. OP must be recognized. ECCO2R can be used in severe OP as a bridge to recovery while waiting for the corticosteroid efficacy.
Subject(s)
Extracorporeal Membrane Oxygenation , Life Support Care/methods , Pneumonia/therapy , Carbon Dioxide/pharmacokinetics , Extracorporeal Membrane Oxygenation/methods , Female , Humans , Intensive Care Units , Middle Aged , Pneumonia/pathology , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Severity of Illness IndexABSTRACT
INTRODUCTION: Constrictive pericarditis is associated with thickening, fibrosis or inflammation of the pericardium which can lead to signs of right ventricle dysfunction. It is usually a chronic process which can present in a variety of ways. We present two cases of constrictive pericarditis discovered during the investigation of a left-sided pleural effusion. OBSERVATION: The cases represent two sorts of constrictive pericarditis, chronic and due to pericardial effusions. Their common feature was an increase in dyspnoea and a new pleural effusion on the left side. Their difference lies in the presence of a thickened calcified pericardium in one case and the presence of a pericardial effusion in the other. In both cases, non-invasive investigation failed to diagnose any cardiac disease. The presence of constrictive pericarditis was confirmed by right heart catheterization. Treatment by subtotal pericardectomy was effective. CONCLUSION: The thoracic manifestations of constrictive pericarditis are most commonly recurring bilateral pleural effusions. The mode of presentation may be an exudative, or transudative effusion. Unilateral pleural involvement, fibrosis, chylothorax or tumour like presentations may occur. A diagnosis of constrictive pericarditis should be considered in these clinical contexts and an examination of the pericardium performed. Cardiac catheterization can help in the differential diagnosis.