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[Case of lymphangioleiomyomatosis (LAM) discovered during cesarean section under spinal anesthesia].
[lymphangioleiomyomatosis]
We
experienced
a
case
of
scheduled
cesarean
section
under
spinal
anesthesia
in
a
patient
with
LAM
which
had
been
missed
in
spite
of
preoperative
medical
examination
and
consultation
with
specialists
but
discovered
because
of
perioperative
hypoxia
A
35
-
year
-old
woman
,
Gravida
1
Para
0
,
with
breech
presentation
was
scheduled
to
undergo
cesarean
section
under
spinal
anesthesia
at
38
weeks
of
gestation
.
She
had
no
history
of
asthma
or
abnormal
findings
at
annual
medical
examination
.
She
had
suffered
from
dry
cough
and
nocturnal
dyspnea
for
7
weeks
and
an
inhaled
bronchodilator
was
administered
with
diagnosis
of
inflammatory
airway
disease
by
her
respiratory
physicians
.
Spinal
anesthesia
was
performed
with
bupivacaine
12
.
5
mg
.
At
the
beginning
of
anesthesia
SPO
2
was
97
%
in
supine
position
,
but
it
rapidly
decreased
to
less
than
90
%
and
3
l
x
min
(
-
1
)
oxygen
was
supplied
with
a
facial
mask
.
The
anesthetic
level
was
thoracal
4
bilaterally
and
her
breathing
was
stable
.
The
circulatory
state
,
Apgar
score
and
other
vital
signs
were
within
normal
ranges
.
Postoperative
chest
X-
ray
showed
bilateral
numerous
grained
spots
and
computed
tomography
scans
showed
multiple
thin
-walled
cysts
.
The
characteristic
history
and
the
fluoroscopic
data
gave
her
clinical
diagnosis
of
LAM
.
