Laparoscopy in diagnosis of pelvic tuberculosis.

We have recently seen a 21-year-old primigravida who had eclampsia at term. 6 h post-partum she became acutely dyspnoeic with P02 36 mm Hg in room air. The hypoxaemia did not respond well to oxygen. Serial X-rays revealed diffuse alveolar infiltrates. The differential diagnosis between cardiogenic and non-cardiogenic pulmonary oedema was made difficult by the marked cardiomegaly on chest X-ray, a finding of uncertain significance in pregnancy. A Swan-Ganz catheter was inserted and pulmonary capillary wedge pressure of 7-8 mm Hg supported a diagnosis of non-cardiogenic pulmonary oedema or adult respiratory distress syndrome (ARDS). The underlying pathophysiology of ARDS is a loss of alveolar-capillary membrane permeability resulting in extravasation of fluid, protein, and fibrin debris into the pulmonary interstitium and alveoli.3 The distinction from cardiogenic pulmonary oedema, although critical, is frequently difficult on clinical grounds, and Swan-Ganz pulmonary arterial catheterisation is indicated to differentiate these conditions and to aid treatment. 4