We report a case of a ruptured pulmonary arteriovenous fistula (PAVF) which caused shock. A 72-year-old woman was transferred from a local hospital to our hospital because of sudden onset of left chest pain that followed hypotension and left pleural effusion. A suspended rupture of an aortic aneurysm was suggested, but results of transesophageal echocardiography and enhanced computed tomography provided no evidence of this diagnosis. Also, aortography performed on the 2nd hospital day, revealed no abnormalities of the intercostal and bronchial arteries, nor the source of the hemothorax. On the 3rd hospital day, she developed shock due to recurrent bleeding, therefore, probe thoracotomy was performed. Pulsative bleeding from the lung surface of the left S8 segment was observed and a diagnosis of a ruptured PAVF was confirmed. Left lower lobectomy was carried out and she was discharged on the 26th hospital day. There are few reports describing the intrapleural rupture of PAVF. This case suggests that pulmonary arteriography should be considered in addition to aortography in patients with sudden onset of chest pain and hemothorax.
We report a case of gastric rupture caused by cardiopulmonary resuscitation (CPR). The patient was a 60-year-old man who had undergone cardiopulmonary arrest (CPA) soon after an arrhythmic event at his office. A bystander had performed CPR for the patient until the paramedic crew arrived. The crew then performed electrical defibrillation, which resulted in the recovery of the patient's spontaneous circulation, at which time he was admitted to the critical care unit of our hospital. On admission, abdominal CT and radiographic examinations revealed a large volume of free air in his abdominal cavity. The case was diagnosed as gastro-intestinal rupture caused by CPR. Emergency suturing of the gastric lining was carried out following initial coronary angiography. The patient survived this surgical intervention and was subsequently discharged without disabilities. This is a rare case of gastric rupture as a complication of CPR, which to date, has been documented in only 8 cases including ours in the Japanese literature. Gastric rupture as a complication of CPR has never been reported as the direct cause of death among the deceased cases. Nonetheless, our report as well as those of the past underscore the importance of correctly administering CPR so as to avoid complications such as gastric rupture.