Transient Disturbance of Pulmonary Blood Flow and Subsequent Pressure Overloading in the Right Ventricle Following the Inhalation of a Water-proof Spray

Abstract

We describe the case of a 42 year-old man who complained of chest pain and dyspnea following the inhalation of a water-proof spray containing 1, 1, 1-trichloroethane (TCE). An electrocardiogram on admission showed right axis deviation and SIQIII pattern in limb leads. A 2-dimensional echocardiogram revealed an asynergy of the right ventricular wall with a dilatation consistent with pressure overloading in the right ventricle. His chest X-ray showed a hyperlucent area in the right lower lung field and interstitial shadow in all lung fields except the right lower field. A ventilation/perfusion lung scan was performed and demonstrated on unmatched perfusion defect in both upper lung fields. Conventional pulmonary arteriography showed multiple segmental vasoconstriction in right A3. The abnormalities on the electrocardiogram and echocardiogram improved within a few days and a perfusion lung scintigram repeated 6 months after the inhalation of the water-proof spray was normal. These findings suggest that inhalation of a water-proof spray induced transient disturbance of pulmonary blood flow with subsequent pressure overloading in the right ventricle. If the effects of TCE on pulmonary circulation is severe enough, resulting acute cor pulmonale with life threatening arrythmias may lead to death asbas been were reported in the past in association with TCE inhalation.