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Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia

Akutes Lungenödem nach Liposuktion infolge Herzversagen und atypischer Pneumonie

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Summary

Microcannular liposuction in tumescent anesthesia is the most effective treatment for painful lipedema. Tumescent anesthesia is an established and safe procedure in local analgesia when performed according to guidelines. Major adverse effects are rare. In patients with advanced lipedema, however, the commonly presented comorbidities bear additional risks.

We report on post-surgical acute pulmonary edema after tumescent liposuction according to guidelines in a 52-year-old female patient with lipedema of the legs. We discuss in detail possible scenarios that might be involved in such emergency. In the present case the most likely was a retarded community acquired atypical pneumonia with aggravation of pre-existent comorbidities.

A combined treatment with intravenous b-lactam antibiosis, positive pressure ventilation, and continuous venovenous hemodialysis and filtration resulted in complete remission in a couple of days. In conclusion, tumescent liposuction of advanced lipedema patients should only be performed in well-trained centers with sufficient infrastructure.

Zusammenfassung

Die mikrokannuläre Liposuktion in Tumeszenzanästhesie ist die wirksamste Behandlungsmethode für das schmerzhafte Lipödem. Die Tumeszenzanästhesie ist ein etabliertes Verfahren der lokalen Analgesie mit großer Patientensicherheit, sofern sie nach bestimmten Leitlinien vorgenommen wird. Schwere Nebenwirkungen sind selten. Allerdings bergen Patienten mit fortgeschrittenem Lipödem aufgrund häufiger Komorbidiäten zusätzliche Risiken.

Wir berichten über die Entwicklung eines postoperativen akuten Lungenödems nach sachgerechter Durchführung einer Tumeszenzliposuktion bei einer 52-jährigen Patientin mit Lipödem der Beine und diskutieren die Szenarien der möglichen Auslösung im konkreten Fall. Wir gehen von einer möglichen Verursachung durch eine einlaufende atypische Pneumonie mit Aggravation vorgestehender Erkrankungen aus.

Die Notfallsituation konnte durch intravenöse Betalaktam-Antibiose in Kombination mit positiver Druckbeatmung und kontinuierlicher venovenöser Hämodialyse und –filtration beherrscht werden. Es kam innerhalb weniger Tage zu einer kompletten Remission. Schlußfolgernd ist zu sagen, dass die Therapie des fortgeschrittenen Lipödems mittels Liposuktion in Tumeszenzanästhesie nur in Zentren mit ausreichender Erfahrung und Infrastruktur durchgeführt werden sollte.

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Authors and Affiliations

  1. Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany

    Uwe Wollina MD

  2. 2nd Medical Department, Center for Internal Intensive Care and Emergency Medicine, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany

    Andreas Graf MD &  Volkmar Hanisch MD

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  1. Uwe Wollina MD
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  2. Andreas Graf MD
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  3. Volkmar Hanisch MD
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Correspondence to Uwe Wollina MD.

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Wollina, U., Graf, A. & Hanisch, V. Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia. Wien Med Wochenschr 165, 189–194 (2015). https://doi.org/10.1007/s10354-014-0333-6

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