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Radiological Cases of the Month

Marianne B. Jacobs, DO; Maria A. Gieron, MD; Carlos R. Martinez, MD; Alfonso Campos, MD; Beverly P. Wood, MD
Am J Dis Child. 1990;144(8):937-938. doi:10.1001/archpedi.1990.02150320101038.
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A 9-year-old girl was diagnosed with nephrotic syndrome 6 months previously, based on a kidney biopsy showing focal sclerosis with mesangial proliferation. Despite prednisone and cyclophosphamide therapy, she progressed to end-stage renal disease. The patient unexpectedly developed a hypertensive crisis with pulmonary edema and cardiac arrest. Cardiopulmonary resuscitation was immediately initiated and continued for approximately 20 minutes. At that time ventilation was difficult and arterial oxygen saturation was 60%. She remained cyanotic despite intubation, and the arterial blood gas results were a pH of 7.26, a PO2 of 38, and a PCO2 of 41 at the time of transfer to a critical care unit. A neurologic evaluation was not performed while she was intubated because pharmacologic paralysis was required. After 72 hours of assisted ventilation and daily hemodialysis the patient's endotracheal tube was removed. She was alert with generalized weakness. During the next week the patient developed involuntary

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