ABSTRACT
Left atrial myxomas are rare cardiac tumours. When diagnosed, these need to be surgically excised as early as possible as these are known to cause dangerous complications, e.g. intracardiac obstruction and embolism. But when presented as an incidental finding on routine echocardiography in a patient presenting with epigastric hernia it creates a clinical dilemma as to which surgery should be performed first. We present one such case of left atrial myxoma in a 58 year old male patient, who underwent hernioplasty under general anesthesia with thoracic epidural analgesia
ABSTRACT
Reexpansion pulmonary edema is a rare form of acute lung injury following rapid re inflation of collapsed lung parenchyma. It can rarely be associated with anaesthesia and repair of traumatic diaphragmatic hernia.We report a case of reexpansion pulmonary edema [REPE] occurring during repak of traumatic diaphragmatic hernia in an adult male. He was a victim of occupational trauma and presented to casualty with complaints of dyspnoea and left sided chest discomfort soon after the injury. Oxygen supplementation was administered via simple face mask to compensate for his hypoxemia. Chest radiograph revealed left diaphragmatic hernia and he was taken up for surgery. Under general anaesthesia with two lung ventilation and epidural analgesia via a thoraco-abdominal approach reduction of abdominal contents with diaphragmatic repair was undertaken. Intraoperatively within an hour of lung expansion he developed pulmonary edema. In spite of altered ventilation perfiision dynamics in the lateral decubitus position he was successfully treated on table. He recovered after a couple of days of invasive ventilatory support. Prompt diagnosis and treatment can reduce the lethality of this condition