PMC3272534_01
Immediate postoperative chest AP radiograph shows increased opacity in bilateral perihilar areas.
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F1
After reintubation, a large amount of pinkish, frothy secretion was suctioned from the endotracheal tube, arterial blood gas analysis (ABGA) showed a pH of 7.24, arterial carbon dioxide tension (PaCO2) of 55.6 mmHg, arterial oxygen tension (PaO2) of 47.9 mmHg and arterial oxygen saturation (SaO2) of 74.1% at an FiO2 of 1.0 and chest X-ray showed increased opacity in bilateral perihilar areas (Fig. 1), consistent with NPPE.
Postoperative electrocardiogram shows ST segment elevation in leads V2-4 and T-wave inversion in leads I, aVL, V2-6.
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F2
The 12-lead EKG revealed ST-segment elevation in leads V2-4 and T-wave inversion in leads I, aVL, V2-6 (Fig. 2).
Transthoracic echocardiography shows left ventricular dysfunction with apical ballooning resembling the octopus trap (takotsubo).
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F3
The echocardiogram revealed akinesia of the left ventricular wall from mid to apex causing apical ballooning (Fig. 3) and a reduced EF of 47%.