17/11/2023
Ini bukannya gambar ranting pokok, ia merupakan cast pokok paru paru (bronkial) yang telah keluar dari seorang pesakit jantung yang mengalami batuk teruk. 😱😱
Seorang lelaki berusia 36 tahun di masukkan ke wad ICU kerana masalah lemah jantung yang semakin serius.
Sebelum ini,pesakit mempunyai pelbagai komplikasi berkaitan jantung dan pernah melakukan pelbagai prosedur seperti mengantikan injap jantung, perentak jantung gantian dan lain lain.
Semasa dirawat di hospital, pesakit telah mengalami gejala batuk berdarah dan sukar untuk bernafas. Bantuan oksigen perlu tingkatkan dari masa ke semasa .
Pada suatu hari, pesakit batuk dengan SANGAT KUAT sehingga terkeluar satu objek seperti ranting pokok yang berdarah. Ia adalah sebahagian kast bronkial paru-paru kanan beliau
Bantuan kecemasan di berikan, pesakit ditidurkan dan di beri alat bantuan pernafasan. Kamera di masukkan melalui tiub dan mendapati terdapat pendarahan di dalam paru paru.
Dua hari kemudian, pesakit dibangunkan tanpa masalah batuk berdarah. Namun akhirnya pesakit meninggal selepas seminggu akibat daripada lemah jantung.
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36-year-old man was admitted to the intensive care unit with an acute exacerbation of chronic heart failure.
His medical history included heart failure with an ejection fraction of 20%, bioprosthetic aortic-valve replacement for bicuspid aortic stenosis, endovascular stenting of an aortic aneurysm, and placement of a permanent pacemaker for complete heart block.
An Impella ventricular assist device was placed for management of acute heart failure, and a continuous heparin infusion was initiated for systemic anticoagulation.
During the next week, the patient had episodes of small-volume hemoptysis, increasing respiratory distress, and increasing use of supplemental oxygen (up to 20 liters delivered through a high-flow nasal cannula).
During an extreme bout of coughing, the patient spontaneously expectorated an intact cast of the right bronchial tree.
The right bronchial tree consists of three segmental branches in the upper lobe (blue arrows), two segmental branches in the middle lobe (white arrows), and five segmental branches in the lower lobe (black arrows).
The patient’s trachea was subsequently intubated, and flexible bronchoscopy revealed a small amount of blood in the basilar branches of the right lower lobe. The patient was extubated 2 days later and had no further episodes of hemoptysis.
One week after extubation, he died from complications of heart failure (volume overload and poor cardiac output) despite placement of the ventricular assist device.
Sumber
New England Journal
