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ACCP-SEEK Board Review Question of the Month |

A 50-Year-Old Woman With Gradual Deterioration of Oxygenation After Lung Transplantation

Stephanie Levine, MD, FCCP
Author and Funding Information

*From the ACCP-SEEK program, reprinted with permission. Items are selected by Department Editors Richard S. Lirwin, MD, FCCP, and John G. Weg, MD, FCCP. For additional information about the ACCP-SEEK program, phone 1-847-498-1400.



Chest. 1999;115(1):267-268. doi:10.1378/chest.115.1.267
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A 50-year-old woman develops a gradual deterioration in oxygenation shortly after single lung transplantation. This patient, with alpha-1-antitrypsin deficiency, undergoes right lung transplantation for emphysema. The surgery performed through a right thoracotomy is uncomplicated and the patient is transferred to the ICU for recovery. Shortly after arrival, the nurses notice a gradual but persistent deterioration in her oxygenation. Pulmonary artery balloon flotation catheter readings show a pulmonary artery balloon occlusion pressure of 10 mm Hg. The chest tubes are draining serosanguinous fluid without gross blood. A chest roentgenogram is obtained (Figure 1 ). The most likely cause of the patient’s problem is:

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