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Published on: August 26, 2020
Case 327
Maxens Decavèle1, Jérémie Pichon1, Anne Fajac1
1From the Intensive Care Unit (M.D., J.P., A.G., A.P., M.F.), Department of Pathological Anatomy and Cytology, Section of Oncology, Pathology and Molecular Biology (A.F., M.A.), Department of Radiology (A.M.), and Department of Pneumology and Thoracic Oncology and GRC-04 Theranoscan (A.P.), Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Paris, France; Department of Experimental and Clinical Respiratory Neurophysiology (UMRS 1158), INSERM, Sorbonne Université, Paris, France (M.D.); and Intensive Care Unit (R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France (M.D., J.P.).
A smoker with obesity experienced severe respiratory failure and persistent lung opacities, requiring intensive care unit (ICU) admissions. Advanced imaging was used to investigate his complex respiratory condition.
Area of Science:
- Pulmonology
- Critical Care Medicine
- Radiology
Background:
- A 58-year-old male smoker with obesity and chronic renal insufficiency presented with recurrent severe hypercapnic acute respiratory failure.
- The patient reported worsening chronic dyspnea on exertion over six months, leading to two intensive care unit (ICU) admissions within three months.
Observation:
- Physical examination revealed signs of respiratory failure, including wheezing and active abdominal expiration, with bilateral pulmonary crackles.
- Arterial blood gas analysis showed severe respiratory acidosis with hypoxemia (pH 7.15, PaCO2 102 mm Hg, PaO2 67 mm Hg on 6 L/min O2).
- Imaging included noncontrast chest CT, chest MRI without contrast, and 18F-FDG PET/CT.
Findings:
- Persistent bilateral chest radiograph opacities were noted and remained unchanged between ICU admissions.
- The patient's complex medical history includes obesity, stage 3 chronic renal insufficiency, and hebephrenic schizophrenia.
Implications:
- This case highlights the diagnostic challenges in patients with severe respiratory failure and complex comorbidities.
- Multimodality imaging, including PET/CT, may be crucial in elucidating the underlying pathology of unexplained respiratory conditions.
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