Case of the Month December 2016

Submitted by Peyman Kangavari, MD, and Thomas J. Learch, MD.

Respiratory Distress Post-Elective Procedure

39-year-old female with no significant past medical history presents to the ED with chief complaint of respiratory distress.
Prior to arrival to the emergency room, the patient was undergoing liposuction of the abdomen and re-injection of fat into the gluteus musculature (Brazilian buttocks augmentation) at an outpatient surgical center. Patient was extubated after her procedure and taken to PACU. Within minutes of being in the PACU, she developed sudden onset of shortness of breath with associated tachypnea, tachycardia, and hypoxia in the 80s. She was given supplemental O2, with improvement of oxygen saturations. EMS was then called. Per her nurse, she had an uncomplicated liposuction involving her abdomen, flanks, and back.
In the ED, patient reports shortness of breath, and chest pain. The chest discomfort is diffuse, worsened with inspiration. There are no relieving factors. She denies history of cardiac disease or prior history of DVT/PE.
Patient also reports pain in her abdomen and back, and is requesting to lie on her side. She also reports that she feels very anxious, but denies any other complaints.
Physical Exam:
Constitutional: She appears well-developed and well-nourished. She does not appear ill. Mild respiratory distress.
HENT: PERRL. EOMI. Oropharynx clear. MMM.
Cardiovascular: Tachycardic, regular rhythm, normal heart sounds and intact distal pulses.
Pulmonary/Chest: Clear to auscultation.
Abdominal: Large scar over lower abdomen, taped with Steri strips. Diffusely tender to palpation.
Musculoskeletal: Normal range of motion.
Skin: Skin is warm and dry. No rash noted.
Neurologic: No focal neurologic deficit.
Psychiatric: Her mood appears anxious.

CT chest angiogram and CT abdomen and pelvis were ordered from the ED.

For a larger images, please click on Peyman 1 and Peyman 2 .

Figure 1. CT Angiogram Chest

Figure 2. CT Abdomen and Pelvis

What are the findings?

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