Respir Case Rep. 2023; 12(3): 85-89 | DOI: 10.5505/respircase.2023.03360

Ortopedik Cerrahide Diffüz Alveoler Kanama: Embolizmin Ötesini Düþünün - Olgu Sunumu

Bushu Harna¹, Shivali Arya², Lalit Gupta^3
1Ýndus Hastanesi, Mohali, Pencap, Hindistan
²Devlet Týp Fakültesi ve Hastanesi, Chandigarh, Hindistan
³Mevlana Azad Týp Fakültesi, Yeni Delhi, Hindistan

Diffüz alveolar kanama (DAH) korkulan ve hayatý tehdit eden bir komplikasyondur. Postoperatif ortope-dik hastalarda nadiren bildirilmesine raðmen, litera-türde az sayýda yað embolisi ile iliþkili DAH olgusu bildirilmiþtir. Diffüz alveolar hemoraji ile prezente, taný konmamýþ vasküliti olan postoperatif intramedül-ler femur hastasýný sunuyoruz. Elli altý yaþýnda erkek, sað femur kýrýðý sonrasý kilitli bir çivi takýlarak opere edildi. Postoperatif 4. günde hastada, hemoptizi, nefes darlýðý ve diffüz alveoler kanamadan (DAH) kaynaklanan hematokritte ani bir düþüþ saptandý. Pulmoner anjiyografi ve diðer incelemelerde pulmo-ner tromboemboli veya yað embolisi görülmedi. Daha sonra vaskülitten þüphelenildi ve cANCA (PR3) antikorlarý pozitif bulundu. Hasta, kortikosteroid, metotreksat ve oksijen desteði ile tedavi edildi. Bir yýllýk takipte femur kýrýðý solunum sorunu olmadan iyileþti. Sonuç olarak, vaskülit, ortopedik cerrahi son-rasý hastalarda nadir görülen bir DAH nedeni olsa da akýlda tutulmalýdýr.

Anahtar Kelimeler: Diffüz alveoler kanama, Ortopedik cerrahi, solunum zorluðu, vaskülit, bronkoaveolar lavaj, solunum zorluðu.

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Diffuse Alveolar Hemorrhage in Orthopaedic Surgery: Think Beyond Embolism - A Case Report

Bushu Harna¹, Shivali Arya², Lalit Gupta^3
1Indus Hospital, Mohali, Panjab, India
²Government medical college and hospital, Chandigarh, India
³Maulana Azad Medical College, New Delhi, India

Diffuse alveolar hemorrhage (DAH) is a dreaded and life-threatening complication. Although it is rarely reported in postoperative orthopaedic patients but few cases of fat embolism-associated DAH had been reported in the literature. We report a postoperative intramedullary femur patient with underlying undiag-nosed vasculitis presenting as diffuse alveolar hemor-rhage. A 56-year-old gentleman suffered a right femur fracture, managed with an interlocking nail. On postoperative day 4, the patient presented with hemoptysis, dyspnea, and a sudden fall in hematocrit suspecting diffuse alveolar hemorrhage (DAH). Pul-monary angiography and other investigations were not suggestive of pulmonary tromboembolism or fat embolism. Vasculitis was then suspected and cAN-CA(PR3) antibodies were positive. The patient was managed with corticosteroids, methotrexate, and oxygen supplementation. At 1 year follow-up, the femur fracture had united with no respiratory problem. As a conclusion, vasculitis, though a rare cause of DAH in post-operative orthopaedic surgery patients should be kept in mind.

Keywords: Diffuse alveolar hemorrhage, orthopaedic surgery, respiratory distress, vasculitis, bronchoaveo-lar lavage, respiratory distress.

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ATIF KOPYALA