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Cardiovascular Instability Caused by Inadvertent Positive End-Expiratory Pressure in a Patient with Panlobular Emphysema Receiving Mechanical Ventilation

Radiographic—Physiologic Correlation

Anastasia V. Deliganis1, Kenneth P. Steinberg2 and Eric J. Stern1

1 Department of Radiology, Harborview Medical Center, Box 359728, University of Washington, Seattle, WA 98104.
2 Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104.



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  		Fig. 1A. —42-year-old woman with chronic obstructive pulmonary disease. Initial chest radiograph, obtained after intubation, shows basilar-predominant pulmonary emphysema and multiple areas of linear atelectasis consistent with "Ritalin [Ciba-Geigy, Summit, NJ] lung."

 


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  		Fig. 1B. —42-year-old woman with chronic obstructive pulmonary disease. Chest radiograph, obtained after change in mechanical ventilation with subsequent labile vital signs, shows extensive and increased air-trapping at lung bases, particularly on left lung, with new eversion of left hemidiaphragm. Heart size is markedly decreased from that seen in A.

 


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  		Fig. 1C. —42-year-old woman with chronic obstructive pulmonary disease. Chest radiograph, obtained after correction of mechanical ventilation and subsequent stabilization in vital signs, shows lung bases, diaphragm, and heart have returned to baseline appearance.

 

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