18787726 Visualization

A 63 Age - year Age - old Age woman Sex with no History known History cardiac History history History presented Clinical_event with a sudden Detailed_description onset Detailed_description of dyspnea Sign_symptom requiring intubation Therapeutic_procedure and ventilatory Therapeutic_procedure support Therapeutic_procedure out Nonbiological_location of Nonbiological_location hospital Nonbiological_location .
She denied preceding symptoms of chest Biological_structure discomfort Sign_symptom , palpitations Sign_symptom , syncope Sign_symptom or infection Disease_disorder .
The patient was afebrile Sign_symptom and normotensive Sign_symptom , with a sinus Detailed_description tachycardia Sign_symptom of 140 Lab_value beats/min Lab_value .
The cardiorespiratory Diagnostic_procedure examination Diagnostic_procedure was remarkable for an elevated Lab_value jugular Diagnostic_procedure venous Diagnostic_procedure pressure Diagnostic_procedure at the angle Biological_structure of Biological_structure the Biological_structure jaw Biological_structure , a left Detailed_description - sided Detailed_description third Sign_symptom heart Sign_symptom sound Sign_symptom and bibasilar Detailed_description crackles Sign_symptom in both Biological_structure lung Biological_structure fields.
The complete Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure count Diagnostic_procedure , electrolytes Diagnostic_procedure and cardiac Diagnostic_procedure biomarkers Diagnostic_procedure were within Lab_value normal Lab_value limits Lab_value .
An initial electrocardiogram Diagnostic_procedure revealed ST Sign_symptom depression Sign_symptom in leads Diagnostic_procedure V2 Diagnostic_procedure to Diagnostic_procedure V6 Diagnostic_procedure , suggestive of anterolateral Disease_disorder ischemia Disease_disorder (Figure 1).
A chest Biological_structure radiograph Diagnostic_procedure demonstrated pulmonary Biological_structure vascular Sign_symptom congestion Sign_symptom consistent with a diagnosis of pulmonary Disease_disorder edema Disease_disorder (Figure 2).
An echocardiographic Diagnostic_procedure examination Diagnostic_procedure revealed normal Lab_value cardiac Diagnostic_procedure dimensions Diagnostic_procedure , normal Lab_value wall Diagnostic_procedure motion Diagnostic_procedure and mild Severity diastolic Disease_disorder dysfunction Disease_disorder with an early Diagnostic_procedure diastolic Diagnostic_procedure to Diagnostic_procedure late Diagnostic_procedure diastolic Diagnostic_procedure transmitral Diagnostic_procedure ratio Diagnostic_procedure of less Lab_value than Lab_value 1 Lab_value , prolonged Lab_value deceleration Diagnostic_procedure time Diagnostic_procedure ( 250 Lab_value ms Lab_value ) and a reduced Lab_value early Diagnostic_procedure diastolic Diagnostic_procedure annular Diagnostic_procedure velocity Diagnostic_procedure of the lateral Biological_structure mitral Biological_structure valve Biological_structure annulus Biological_structure .
Following aggressive Lab_value diuresis Sign_symptom and requiring minimal Lab_value ventilatory Therapeutic_procedure support Therapeutic_procedure , the patient was extubated Therapeutic_procedure one Date day Date following Date her initial presentation.
Within Time 1 Time h Time of extubation Coreference , the patient developed recurrent Detailed_description pulmonary Disease_disorder edema Disease_disorder clinically and radiographically Diagnostic_procedure , requiring mechanical Therapeutic_procedure ventilation Therapeutic_procedure .
Cardiac Diagnostic_procedure catheterization Diagnostic_procedure was performed and revealed normal Lab_value coronary Biological_structure arteries Biological_structure .
On Date day Date 4 Date of the coronary Nonbiological_location care Nonbiological_location unit Nonbiological_location admission Clinical_event , the patient failed Clinical_event a repeat attempt at extubation Therapeutic_procedure .
A computed Diagnostic_procedure tomographic Diagnostic_procedure scan revealed a 4 Area cm Area × Area 9 Area cm Area multinodular Detailed_description goiter Disease_disorder extending into the mediastinum Biological_structure and suspected associated tracheal Biological_structure stenosis Sign_symptom (Figure 3).
With a diagnosis of NPPE Disease_disorder secondary to an enlarged Severity goiter Disease_disorder , the patient underwent surgical Therapeutic_procedure intervention Therapeutic_procedure for a thyroidectomy Therapeutic_procedure .
Intraoperative Detailed_description bronchoscopy Diagnostic_procedure revealed tracheal Biological_structure stenosis Sign_symptom of greater Lab_value than Lab_value 50% Lab_value .
The postoperative Diagnostic_procedure course Diagnostic_procedure was uncomplicated Lab_value , and three Date months Date following Date discharge Clinical_event , the patient returned Outcome to her previous Detailed_description activity Detailed_description level Detailed_description without subjective dyspnea Sign_symptom .