Flow phenomena, differential diagnose of the refractary hipoxemy in patients with anterior mediastinal mass. Case report

Introduction Refractory hypoxaemia is a critical, life-threatening condition if not resolved promptly. The flow phenomenon is implicated in its development. Objectives Clinical case presentation and non-systematic review of the literature on refractory hypoxaemia and flow phenomenon. Incidence, aetiology and pathophysiology are described. Material and methods Clinical case presentation authorised by the Ethics Committee of our institution of a young patient who presented with progressive dyspnea, reaching functional class IV/IV. A search of the literature was conducted in Pub Med, Scielo and Bireme. Results There is a growing interest in the physiological flow phenomenon leading to the development of refractory hypoxaemia in the absence of increased pressure in the cardiac cavities. Few reports are found. Conclusions Flow phenomenon-related refractory hypoxaemia must be suspected as an exclusion diagnosis in patients with a mediastinal mass. Prone ventilation is proposed as a bridging therapy in order to revert a life-threatening condition.