病例报告肺病

高压氧治疗(HBOT)继续显示在治疗一些疾病的有效性和益处，如成纤维细胞增殖，毛细血管血管生成和减少水肿，特别是在出血性膀胱炎(HC)。我们报告一例15岁男性慢性粒细胞性白血病的病例，在美国使用HBOT治疗与BK病毒完全相同的干细胞运输。患者在2 ATA共接受了30个HBOT治疗90分钟。经过HBOT治疗，病人表现出改善的迹象，如止血膀胱炎停止。该病例的研究结果支持并表明，越来越多的证据表明HBOT作为干细胞移植后与HC相关的BK病毒患者的辅助治疗。

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我们报告一个80岁的女人谁提出心跳呼吸骤停的一个情节和急性呼吸道阻塞的两分集的情况下。我们在这个病人造成气管软化megaesophagus的存在压缩继发于失弛缓症可能是造成急性呼吸道梗阻和心跳呼吸骤停的事件中。

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支气管静脉曲张是一种罕见的肺部疾病，可导致危及生命的出血。由于影像学和支气管镜检查的微小异常，诊断困难。我们报告一例因支气管静脉曲张出血而造成大咯血的病例。在关岛岛上，由于没有立即进行复杂的支气管内治疗，该病例最初采用喷雾和静脉注射氨甲环酸治疗。其次是支气管内肾上腺素灌注阻塞出血气道。选择性支气管动脉栓塞减轻了急性期出血。由于血凝块影响了双侧支气管气道的通畅，严重缺氧而开始俯卧位。俯卧位采用俯卧通气17小时，连续2天，间断支气管镜钳取气道血凝块。这些动作改善了肺通气和氧合。患者接受了支气管袖切除手术以明确治疗。

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电子烟，或vaping产品使用相关急性肺损伤（EVALI），是一组与先前已经归类为排除性的诊断和最好被描述为外源性脂质肺炎或化学性肺炎vaping和电子香烟产品相关的肺部疾病的。在这里，我们使用含大麻，电子烟描述一个原本健康的病人类脂性肺炎的外生原因的发作。我们在临床病例探讨相似之处，定义与疾病的进展，与病理诊断和管理的特性以及影像学检查常见的临床表现。

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在此报告中，我们报告一例复杂的社区获得性肺炎在一个5岁男孩。病人首先到肺科诊所诊断为哮喘和最近的肺炎复发史。两个疗程的门诊口服抗生素的依从性不佳，导致持续的肺炎症状，未得到明确的影像学检查结果，需要使用非肠道抗生素。尽管2周无症状，病人回到急诊科症状复发，影像学显示空洞的病变需要一个长期的非肠道抗生素疗程。本报告进一步证实了部分治疗感染与抗生素治疗方案依从性差相关的有害影响。

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肺切除术后综合征涉及纵隔移位经由主支气管和远侧压迫气管造成动态气道阻塞。少数病例报告患者肺切除术后综合征急性呼吸窘迫综合征的发展。里布等。（2017）从33％描述肺切除术后的死亡率ARDS任何地方88％。一个可能会遇到气管插管和通风困难，因为根据理想体重参数可能不适用。俯卧位通气和ECMO已在个别情况下已经成功地使用。我们目前在管理这样的情况下和突出的挑战。一位70岁的男性越战老兵与右全肺切除30年远程历史前出现发烧，咳嗽和呼吸困难。Physical exam was significant for T 36.3°C, BP 162/73, heart rate 145 BPM, RR 22 breaths/minute, ht. 1.72 m, and wt. 78 kg, with transmitted right lung sounds and rhonchi on the left. Labs showed WBC 23.92/nL and procalcitonin 0.84 ng/mL. CXR showed left infiltrate and opacification of right hemithorax with right mediastinal shift. EKG showed atrial fibrillation. He was started on broad spectrum antibiotics for pneumonia, but deteriorated, and was intubated for respiratory distress from ARDS. Vasopressors were initiated for shock. Given the history of pneumonectomy, he was initially ventilated with lower tidal volumes (320 mL). However, incremental changes were made to tidal volumes, and ETT was repositioned several times for hypoxia. Epoprostenol and cisatracurium were also initiated. Positional changes would lead to sudden desaturation; hence, prone positioning ventilation was not done. He was not considered for ECMO due to his pneumonectomy status. Unfortunately, his condition worsened progressively and he expired. The guidelines for ARDS are well established. However, postpneumonectomy patients are unique as seen in our patient. It is unclear whether an endobronchial tube advanced into the left bronchus could have helped difficult airway management resulting from suspected postpneumonectomy syndrome as suggested by CXR. Higher tidal volumes were also unsuccessful in alleviating hypoxia and led to persistently elevated plateau pressures and driving pressures as high as 23, which was inconsistent with our goal of lung protective ventilation. Few case reports describe the successful use of prone positioning ventilation or ECMO in postpneumonectomy patients with ARDS. Although not well studied, low tidal volumes supported with ECMO may have been a favorable strategy for our patient.

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