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Severe Refractory Hypoxemia Following a Gunshot Injury*

Ismail T. Dairywala, MD; Juzar Lokhandwala, MD; Herbert Patrick, MD, FCCP; Raymond Talucci, MD; Diwakar Jain, MD
Author and Funding Information

*From the Divisions of Cardiology (Drs. Dairywala and Jain) and Pulmonary/Critical Care (Dr. Patrick), the Department of Internal Medicine (Dr. Lokhandwala), the Division of Trauma (Dr. Talucci), Department of Surgery, Drexel University College of Medicine, Philadelphia, PA.

Correspondence to: Diwakar Jain, MD, Drexel University College of Medicine, 245 N Fifteenth St, MS-470, Philadelphia, PA 19012-1192; e-mail: Diwakar.Jain@drexel.edu



Chest. 2005;127(1):398-401. doi:10.1378/chest.127.1.398
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We describe the case of a 57-year-old man with severe refractory hypoxemia, despite receiving ventilation therapy with 100% oxygen, following a gunshot wound to his left chest. A limited CT scan of the chest with contrast raised the suspicion of an arteriovenous (AV) fistula. Contrast-enhanced transthoracic echocardiography confirmed the presence of a pulmonary AV fistula. Traumatic pulmonary AV fistula is a rare, but serious and life-threatening condition that should be suspected in patients with thoracic injuries with persistent unexplained hypoxemia. Contrast echocardiography is a relatively simple, inexpensive, and readily available bedside test that can be used to confirm this diagnosis.

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