SHM Converge Scientific Abstract ePoster Gallery-Negative Pressure Pulmonary Edema With Diffuse Alveolar Hemorrhage: A Rare Postoperative Complication

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This case report describes a rare postoperative complication: negative pressure pulmonary edema (NPPE) with diffuse alveolar hemorrhage (DAH). NPPE occurs when a patient forcefully inhales against an obstructed upper airway, most often after laryngospasm during emergence from anesthesia. The resulting markedly negative intrathoracic pressure can rapidly draw fluid into the lungs, and in severe cases may damage the alveolar-capillary membrane, causing hemorrhage and hemoptysis.<br /><br />The patient was an 18-year-old otherwise healthy male who underwent surgical repair of a distal radius fracture under general anesthesia. During extubation, he developed laryngospasm with severe hypoxia. Positive pressure ventilation was unsuccessful, and propofol was given. After surgery, he developed chest discomfort, hemoptysis, hypoxemia, and new bilateral pulmonary opacities on imaging.<br /><br />Further evaluation helped rule out other causes such as aspiration, cardiogenic pulmonary edema, pulmonary embolism, and vascular injury. CTA showed diffuse bilateral opacities without vascular damage, and cardiac testing, including TTE and pro-BNP, did not support heart failure.<br /><br />He improved over 48 hours with supportive treatment, including high-flow oxygen, bronchodilators, corticosteroids, and diuresis.<br /><br />The report emphasizes that NPPE with DAH should be considered in young patients who develop acute hypoxemia and hemoptysis after extubation or laryngospasm. Early recognition, supportive care, and close monitoring are important because patients can deteriorate quickly despite having few or no comorbidities.

Asset Subtitle

John H. Major

Meta Tag

Author List Adriana J. Sotelo, Denny Joseph, John H. Major, Pranayvir S. Lotey

Category Clinical Vignettes

Concept Negative Pressure Pulmonary Edema

Concept Diffuse Alveolar Hemorrhage

Concept Upper Airway Obstruction

Concept Laryngospasm

Concept Hemoptysis

Distinguished Non-Finalist

Presenter Organization McGovern Medical School at UTHealth Houston

Presenting Author John H. Major

Track Adult

Keywords

negative pressure pulmonary edema

diffuse alveolar hemorrhage

laryngospasm

postoperative complication

extubation

hemoptysis

hypoxemia

general anesthesia

bilateral pulmonary opacities

supportive treatment

Negative Pressure Pulmonary Edema

Diffuse Alveolar Hemorrhage

Upper Airway Obstruction

Laryngospasm

Hemoptysis