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Case Reports in Critical Care
Volume 2013, Article ID 434965, 3 pages
http://dx.doi.org/10.1155/2013/434965
Case Report

The Rendu-Osler-Weber Disease Revealed by a Refractory Hypoxemia and Severe Cerebral Fat Embolism

1Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000 Limoges, France
2CIC-P 0801, Dupuytren Teaching Hospital, 87000 Limoges, France
3University of Limoges, 87000 Limoges, France
4Service de Réanimation Polyvalente, CHU Dupuytren, 2 Avenue Martin Luther King, 87042 Limoges Cedex, France

Received 28 May 2013; Accepted 3 July 2013

Academic Editors: M. Doganay, W. S. Park, and M. Tidswell

Copyright © 2013 Leonel Barreto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The Rendu-Osler-Weber disease is a genetic disease which may lead to severe hemorrhage and less frequently to severe organ dysfunction. We report the case of a 22-year-old patient with no personal medical history who was involved in a motorcycle accident and exhibited severe complications related to large arteriovenous pulmonary shunts during his ICU stay. The patient developed an unexplained severe hypoxemia which was attributed to several arteriovenous shunts of the pulmonary vasculature by a contrast study during a transesophageal echocardiographic examination. The course was subsequently complicated by a prolonged coma associated with hemiplegia which was attributed to a massive paradoxical fat embolism in the setting of an untreated femoral fracture. In addition to hemorrhagic complications which may lead to intractable shock, arteriovenous malformations associated with the Rendu-Osler-Weber disease may involve the pulmonary vasculature and result in unexpected complications, such as hypoxemia or severe cerebral fat embolism in high-risk patients.