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Acute Diastolic Dysfunction Due to Pneumomediastinum Following Positive End-Expiratory Pressure

A Case Report

Department of Cardiovascular Disease, Cittadella Civic Hospital, Padua, Italy, emodinacit{at}ulss15.pd.it

Mario Zanchetta, MD

Department of Cardiovascular Disease, Cittadella Civic Hospital, Padua, Italy

Luigi Pedon, MD

Department of Cardiovascular Disease, Cittadella Civic Hospital, Padua, Italy

Marco Zennaro, MD

Department of Cardiovascular Disease, Cittadella Civic Hospital, Padua, Italy

Pietro Maiolino, MD

Department of Cardiovascular Disease, Cittadella Civic Hospital, Padua, Italy

A 78-year-old woman was admitted for pulmonary embolism requiring orotracheal intubation and positive end-expiratory pressure. The pulmonary angiography confirmed a massive pulmonary embolism as suggested by echocardiography. Heparin and recombinant tissue plasminogen activator were successfully administrated; nevertheless, cardiogenic shock developed. A diastolic morphology of the right-left cardiac pressures, despite a normalization of lung vasculature, was discovered by a repeated cardiac catheterization and pulmonary angiography. No tamponade was detected by echocardiography. Computed tomography demonstrated a large pneumomediastinum caused by positive end-expiration pressure, as a cause of the acute diastolic dysfunction. The patient died of a cardiac arrest after an unsuccessful drainage attempt.

Angiology, Vol. 55, No. 4, 441-443 (2004)
DOI: 10.1177/000331970405500411


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