Nitric oxide/sildenafil
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Pulmonary oedema: case report A 5-year-old boy developed pulmonary oedema while receiving sildenafil and nitric oxide. The boy presented with easy fatigability. He experienced one episode of syncope. Clinically, he had severe pulmonary artery hypertension (PAH). Echocardiogram confirmed PAH with moderate right ventricular systolic dysfunction. Chest X-ray showed mild cardiomegaly with dilated right atrium. Initially, high resolution CT was unremarkable. He was receiving sildenafil [route an dosage not stated] and unspecified diuretics. He was referred in view of no significant clinical response. He then underwent cardiac catheterisation with acute vasodilator testing (AVT) under conscious unspecified sedation and unspecified local anaesthesia. On initiation of inhaled nitric oxide 20ppm for AVT, his pulmonary artery pressure increased, and his oxygen saturations decreased requiring intubation. Examination showed bilateral extensive crepitations with frothy sputum, indicating flash pulmonary oedema. Therefore, inhaled nitric oxide was discontinued, and the boy was stabilised with unspecified diuretics and unspecified inotropes. Chest X‑ray indicated pulmonary oedema. Further follow-up X-ray showed cleared pulmonary oedema. Repeat chest HRCT showed multifocal ground glass opacities, thickening of interlobar fissures, prominent pulmonary arteries and normal caliber pulmonary veins, all of which were highly indicative of pulmonary veno occlusive disease (PVOD; underlying condition). His pulmonary oedema was attributed to PVOD, sildenafil and nitric oxide [duration of treatment to reaction onset not stated]. Subsequently, he was discharged on unspecified diuretics and was referred for lung/heart lung transplant. Sharma A, et al. Pulmonary hypertension secondary to pulmonary veno occlusive disease: Catastrophe in the catheterization laboratory. Annals of Pediatric Cardiology 13: 803519457 377-379, No. 4, Oct-Dec 2020. Available from: URL: http://doi.org/10.4103/apc.APC_142_20
0114-9954/20/1833-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 5 Dec 2020 No. 1833
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