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"Neurologist's contribution to the diagnosis of sine materia respiratory insufficiency: case report".

BMC Pulm Med

August 2012

Pulmonology Unit, Department of Cardiology, Thoracic and Vascular Surgery and Critical Care Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.

Background: Right-to-left shunt (RLS) may be the cause of marked hypoxemia, a respiratory insufficiency which is usually difficult to diagnose by respiratory physicians as it develops in the absence of an intrinsic lung disease.

Case Presentation: We report a case of RLS in a patient with a hepatopulmonary syndrome caused by chronic autoimmune cholangitis. RLS was suspected clinically by physical examination and by standard CT imaging and MIP reconstruction of the pulmonary vascular bed.

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Background: The systolic pulmonary artery pressure (PAPs) can be accurately estimated, non-invasively, using continuous-wave Doppler (CWD) ultrasound measurement of the peak velocity of a tricuspid regurgitant (TR) jet. However, it is often difficult to obtain adequate tricuspid regurgitation signals for measurement of PAPs, what could lead to its underestimation. Therefore, utilization of air-blood-saline contrast has been implemented for the improvement of Doppler signal in several clinical contexts.

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Background: Severe emphysema frequently is associated with elevated pulmonary artery systolic pressure. However, it is often difficult to obtain adequate tricuspid regurgitation (TR) signals for measurement of pulmonary artery systolic pressure in patients with severe emphysema.

Purpose: This study was conducted to evaluate the usefulness of air-blood-saline mixture in measuring TR velocity in severe emphysema.

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Objectives: We assessed an air-blood-saline mixture for Doppler measurement of pulmonary artery systolic pressure (PASP) and the mechanism of enhancement of the Doppler signal by this mixture.

Background: Underestimation of PASP by Doppler echocardiography occurs with inadequate continuous wave (CW) signals of tricuspid regurgitation (TR).

Methods: We assessed in vitro the diameter and concentration of microbubbles of agitated air-saline mixture, air-blood-saline mixture and 10% air-10% plasma-80% saline mixture immediately, 5, 10 and 20 s after agitation.

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