IMAGES IN EMERGENCY MEDICINE
Extreme cardiac and pulmonary artery compression causing positional oxygen desaturation
Department of Cardiac and Thoracic Surgery, Hamad Hospital, PO Box 3050, Doha, Qatar
Correspondence to:
Dr C S Carr, CCS Department, Hamad General Hospital, PO Box 3050, Doha, Qatar; noahalkh@talk21.com
Accepted 23 December 2006
| The first 150 words of the full text of this article appear below. |
A 30-year-old man presented to accident and emergency with a 6-month history of worsening dyspnoea, with chest x ray showing a widened mediastinum. Pulse oximetry showed desaturation from 93% to 65% when supine. Computerised tomography showed a massive anterior mediastinal mass causing severe cardiac compression inferiorly (coronal reconstruction, fig 1) and severe main pulmonary artery compression. Echocardiography revealed a gradient of 143 mm Hg across the right ventricular outflow tract.
Figure 1 Computerised tomography, coronal reconstruction, showing large anterior mediastinal mass compressing the hart below.
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He rapidly required mechanical ventilation (sitting-up position). At median sternotomy there was a large anterior fluid-filled area and posteriorly there was a solid mass containing hair and sebum. He was extubated after 3 days and made a good recovery. Histology confirmed mature teratoma (grade I/III), completely excised, requiring surveillance only. Postoperative echocardiography showed a residual gradient of 30 mm Hg.
Extrinsic functional "pulmonary stenosis" has previously
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