Journal of Anesthesia

, Volume 23, Issue 3, pp 417–420

Negative-pressure acute tracheobronchial hemorrhage and pulmonary edema

Authors

  • Vasilios Papaioannou
    • Alexandroupolis Medical School, Intensive Care UnitDemocritus University of Thrace
  • Irene Terzi
    • Alexandroupolis Medical School, Intensive Care UnitDemocritus University of Thrace
  • Christos Dragoumanis
    • Alexandroupolis Medical School, Intensive Care UnitDemocritus University of Thrace
  • Ioannis Pneumatikos
    • Alexandroupolis Medical School, Intensive Care UnitDemocritus University of Thrace
Clinical Report

DOI: 10.1007/s00540-009-0757-0

Cite this article as:
Papaioannou, V., Terzi, I., Dragoumanis, C. et al. J Anesth (2009) 23: 417. doi:10.1007/s00540-009-0757-0

Abstract

Negative-pressure pulmonary edema is a well-known complication of an acute upper airway obstruction, which may rarely present as acute alveolar hemorrhage in cases of severe capillary stress failure. Hemorrhage from the central airways has also been reported as a rare manifestation of acute tracheobronchial injury, associated with severe disruption of the bronchial vasculature due to highly negative inspiratory pressure. In this clinical report, we describe a case of both acute tracheobronchial and alveolar hemorrhage in a young man, occurring immediately after extubation due to laryngospasm, diagnosed by bronchoscopy with bronchoalveolar lavage (BAL), measurement of the pulmonary edema fluid/plasma protein ratio, and by thoracic computed tomography (CT) scan. We propose that the patient experienced severe postobstructive negative-pressure pulmonary edema, related to increased permeability of the alveolar capillary membrane and a parallel loss of integrity of the bronchial vascular network. Our findings suggest that both changes in the bronchial circulation and mechanical stress failure of the more distal alveolar-capillary system may be induced by severe and acute upper-airway obstruction.

Key words

Negative-pressure pulmonary edemaPulmonary hemorrhageBronchoscopy

Copyright information

© Japanese Society of Anesthesiologists 2009