Abstract
18 year old non-smoker female from California with pmhx of asthma presented with right knee pain and shortness of breath. On admission, vitals were stable, saturating well on room air. MRI of knee confirmed parietal gastrocnemius tear along with some hyperintensity of bone marrow of femur. Chest X-ray on admission revealed bilateral multifocal opacities. Upon admission, influenza and coccidioides serology were negative. Ultrasound doppler of the right lower extremities revealed deep vein thrombosis. Computerized tomography angiogram chest revealed subsegmental pulmonary embolism within the right lower lobe, with bilateral opacities. Heparin drip for management for acute PE and DVT. Due to decreasing oxygen saturation to 93%, the patient required 4 L/ min via nasal cannula.
Highlights
18 year old non-smoker female from California with pmhx of asthma presented with right knee pain and shortness of breath
We present a successful ECMO application in a COVID -19 positive patient with severe ARDS Keywords: Pulmonary Gangrene, Septic Emboli, ECMO, Necrotizing Pneumonia, Methicillin-resistant Staphylococcus Aureus (MRSA), ARDS, Lung Transplant Abbreviations: PMHX: Past Medical History; MRI: Magnetic Resonance Imaging; PE: Pulmonary Embolism; DVT: Deep Vein Thrombosis; MRSA: Methicillin-Resistant Sathylococcus Aureus; CXR: Chest X-Ray; FiO2: Fractional Inspiration of Oxygen; ECMO: Extracorporeal Membrane Oxygenation; VVECMO: venous-venous Extracorporeal Membrane Oxygenation; VA ECMO: venous-Arterial Extracorporeal Membrane; CCRT: Continuous Renal Replacement Therapy
Necrotizing pneumonia is a highly lethal and rapidly progressive disease affecting young adults. 1-10% can be attributed to Staphylococcus aureus as the pathologic organism [2]
Summary
18 year old non-smoker female from California with pmhx of asthma presented with right knee pain and shortness of breath. Vitals were stable, saturating well on room air. MRI of knee confirmed parietal gastrocnemius tear along with some hyperintensity of bone marrow of femur. Chest X-ray on admission revealed bilateral multifocal opacities. Ultrasound doppler of the right lower extremities revealed deep vein thrombosis. Computerized tomography angiogram chest revealed subsegmental pulmonary embolism within the right lower lobe, with bilateral opacities. Heparin drip for management for acute PE and DVT. Due to decreasing oxygen saturation to 93%, the patient required 4 L/ min via nasal cannula
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