Journal of Anesthesia

, Volume 23, Issue 3, pp 417–420 | Cite as

Negative-pressure acute tracheobronchial hemorrhage and pulmonary edema

  • Vasilios Papaioannou
  • Irene Terzi
  • Christos Dragoumanis
  • Ioannis Pneumatikos
Clinical Report


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 edema Pulmonary hemorrhage Bronchoscopy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tami TA, Chu F, Wildes TO, Kaplan M. Pulmonary edema and acute upper airway obstruction. Laryngoscope. 1986;96:506–509.PubMedCrossRefGoogle Scholar
  2. 2.
    McConkey PP. Postobstructive pulmonary oedem a—a case series and review. Anaesth Intensive Care. 2000;28:72–76.PubMedGoogle Scholar
  3. 3.
    Westreich R, Sampson I, Shaari CM, Lawson W. Negativepressure pulmonary edema after routine septorhinoplasty: discussion of pathophysiology, treatment and prevention. Arch Facial Plast Surg. 2006;8:8–15.PubMedCrossRefGoogle Scholar
  4. 4.
    Patton WC, Baker CL. Prevalence of negative-pressure pulmonary edema at an orthopaedic hospital. J South Orthop Assoc. 2000;9:248–253.PubMedGoogle Scholar
  5. 5.
    Dieu T, Upjohn E. Negative pressure pulmonary edema in healthy cosmetic surgery patients. Aesthetic Surg J. 2003;23:270–273.CrossRefGoogle Scholar
  6. 6.
    Hirano Y, Sugawara T, Sato Y, Sato K, Omae T, Sasajima T, Mizoi K. Negative pressure pulmonary edema following foramen magnum decompression for Chiari malformation type I. Neurol Med Chir (Tokyo). 2008;48:137–139.CrossRefGoogle Scholar
  7. 7.
    Koh MS, Hsu AAL, Eng P. Negative pressure pulmonary oedema in the medical intensive care unit. Intensive Care Med. 2003;29:1601–1604.PubMedCrossRefGoogle Scholar
  8. 8.
    Schwartz DR, Maroo A, Malhotra A, Kesselman H. Negative pressure pulmonary hemorrhage. Chest. 1999;115:1194–1197.PubMedCrossRefGoogle Scholar
  9. 9.
    Broccard AF, Liaudet L, Aubert JD, Schnyder P, Schaller MD. Negative pressure post-tracheal extubation alveolar hemorrhage. Anesth Analg. 2001;92:273–275.PubMedCrossRefGoogle Scholar
  10. 10.
    Sow NY, Garewal D. Pulmonary hemorrhage in association with negative pressure oedema in an intubated patient. Acta Anaesthesiol Scand. 2001;45:911–913.CrossRefGoogle Scholar
  11. 11.
    Devys JM, Balleau C, Jayr C, Bourgain JL. Biting the laryngeal mask: an unusual cause of negative pressure pulmonary oedema. Can J Anesth. 2000;47:176–178.PubMedCrossRefGoogle Scholar
  12. 12.
    Dolinski SY, MacGregor DA, Scuderi PE. Pulmonary hemorrhage associated with negative-pressure pulmonary edema. Anesthesiology. 2000;93:888–890.PubMedCrossRefGoogle Scholar
  13. 13.
    Patel AR, Bersten AD. Pulmonary haemorrhage associated with negative-pressure pulmonary oedema: a case report. Crit Care Resusc. 2006;8:115–116.PubMedGoogle Scholar
  14. 14.
    Koch SM, Abramson DC, Ford M, Peterson D, Katz J. Bronchoscopic findings in post-obstructive pulmonary oedema. Can J Anaesth. 1996;43:73–76.PubMedCrossRefGoogle Scholar
  15. 15.
    Bhavani-Shankar K, Hart NS, Mushlin PS. Negative pressure induced airway and pulmonary injury. Can J Anaesth. 1997;44:78–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Matthay MA, Wiener-Kronish JP. Intact epithelial barrier function is critical for the resolution of alveolar oedema in humans. Am J Respir Crit Care Med. 1990;142:1250–1257.Google Scholar
  17. 17.
    Fremont RD, Kallet RH, Matthay MA, Ware LB. Postobstructive pulmonary edema: a case for hydrostatic mechanisms. Chest. 2007;131:1742–1746.PubMedCrossRefGoogle Scholar
  18. 18.
    Lang SA, Duncan PG, Shephard DAE, Ha HC. Pulmonary oedema associated with airway obstruction. Can J Anaesth. 1990;37:210–218.PubMedCrossRefGoogle Scholar
  19. 19.
    Kollef MH, Pluss J. Non cardiogenic pulmonary oedema following upper airway obstruction. Medicine. 1991;70:91–98.PubMedCrossRefGoogle Scholar
  20. 20.
    Pavlin DJ, Nersley ML, Cheney FW. Increased pulmonary vascular permeability as a cause of re-expansion pulmonary oedema. Am Rev Respir Dis. 1981;124:422–427.PubMedGoogle Scholar
  21. 21.
    Jackson FN, Rowland V, Corssen G. Laryngospasm-induced pulmonary oedema. Chest. 1980;78:819–821.PubMedCrossRefGoogle Scholar
  22. 22.
    Schwarz MI, Albert RK. “Imitators” of the ARDS: implications for diagnosis and treatment. Chest. 2004;125:1530–1535.PubMedCrossRefGoogle Scholar
  23. 23.
    Marland AM, Glauser FL. Hemodynamic and pulmonary edema protein measurements in a case of reexpansion pulmonary edema. Chest. 1982;81:250–251.PubMedCrossRefGoogle Scholar
  24. 24.
    Matthay MA, Folkesson HG, Clerici C. Lung epithelial fluid transport and the resolution of pulmonary edema. Physiol Rev. 2002;82:569–600.PubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2009

Authors and Affiliations

  • Vasilios Papaioannou
    • 1
  • Irene Terzi
    • 1
  • Christos Dragoumanis
    • 1
  • Ioannis Pneumatikos
    • 1
  1. 1.Alexandroupolis Medical School, Intensive Care UnitDemocritus University of ThraceDraganaGreece

Personalised recommendations