PMC9790913_01
(A) A schematic diagram of the twelve-zone scanning lung ultrasound protocol. (B) Lung ultrasound was performed to assess the cause of hypoxemia. Tissue-like signs were found in the region of R6, L5, and L6.
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F1
The result showed tissue-like signs, which indicated lung consolidation, in the regions of R6, L5, and L6 (Figure 1), while lung sliding and A-lines were observed in the other regions.
EIT images of the functional ventilation distribution (A) (dark blue areas indicated low ventilated regions and white areas indicated high ventilated regions), functional perfusion distribution (B) (red areas indicated high-perfusion regions and blue areas indicated low-perfusion regions), and distribution of the regional ventilation/perfusion ratios (C) (Ventilated regions were defined as pixels with impedance changes higher than 20% of the maximum tidal impedance variation in the functional ventilation image. Perfused regions were defined as pixels higher than 20% of the maximum bolus-related impedance change in the functional perfusion image. Gray areas indicated regions with high ventilation and low perfusion. Red areas indicated low ventilation and high perfusion regions. Yellow areas indicated good ventilation-perfusion matching).
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F2
The EIT ventilation image of our patient showed decreased ventilation distribution in the right lung (Figure 2A), which was probably related with the right lateral thoracotomy surgical approach. The dead space of the whole lung was 24.4%, and the shunt was 10.29% (Figures 2B,C).
CTPA demonstrated mild atelectasis in the inferior lobes of bilateral lungs and a small amount of operation related pneumothorax. The small embolism in the superior lobar branch of right pulmonary artery was not shown in the picture.
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F3
CTPA revealed small embolism in the superior lobar branch of the right pulmonary artery (Figure 3).
TEE showed a residual atrial septal defect with a size of 5 mm and bidirectional multicolored shunt flow signal. And an IVC-left atrium shunt was also found soon after the repair. TEE, transesophageal echocardiography; LA, left atrium; RA, right atrium; RV, right ventricle; IVC, inferior vena cava.
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F4
Bidirectional multicolored shunt flow signal was detected through this atrial defect (Figure 4).