Case of the Month: Answer to Case 1
Abstract
The question was:
No need for words.
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What is the abnormality?
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What is your differential diagnosis of this CT of the brain?
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Based on this CT what would the bronchoscopy show?
The answer is:
A 50 year-old woman presented in coma following removal from a house fire. She was intubated at the scene and transported via helicopter to our facility. Admission carboxyhemoglobin concentration was 15.7%. A head CT obtained in the emergency center showed bilateral hypodensities in the globus pallidus. These lesions have been regarded as a pathological hallmark of CO poisoning, but they have been seen in non-CO hypoxic/ischemic injury as well.
Figure 1: Head CT showing bilateral hypodensities in the globus pallidus
The patient underwent emergent hyperbaric oxygen therapy without a change in her neurological condition. She was admitted to the ICU and a bronchoscopy was performed and demonstrated excessive amounts of soot throughout all airways examined. Some erythema was noted as well. See chest x-ray and photograph below. Despite aggressive positive pressure ventilation she expired the day following admission from progressive hypoxemia.
Figure 2: Chest X-Ray
Figure 3: Trachea in endoscopy
Figure 4: Carina in endoscopy
Figure 5: Small airways in endoscopy
Suggested Literature:
Tomson LF, et al. Management of the moribund carbon monoxide victim. Archives of Emergency
Medicine 1992;9:208-213.
Starkstein SE, et al. Psychic Akinesia following bilateral pallidal lesions. International Journal of
Psychiatry in Medicine. 1989;19:155-164.
Please e-mail any comments to : jnates@anes1.med.uth.tmc.edu
