SESSION TITLE: Bronchology/Interventional Global Case Reports
SESSION TYPE: Global Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Postobstructive pulmonary edema (POPE) is an uncommon but important cause of noncardiogenic pulmonary edema, and is categorised as type I (forced inspiration against transient acute upper airway occlusion) and type II (following relief of chronic partial upper airway occlusion).1 We describe a case of type I POPE presenting acutely to Medicine.
CASE PRESENTATION: A 61 year old gentleman presented with a 2 hour history of progressive dyspnea and cough after choking briefly on an antibiotic tablet. His significant past history included radiotherapy 10 years prior for a laryngeal squamous cell carcinoma. Examination revealed hypoxemia, sinus tachycardia, and bilateral lung crackles, and chest radiographic appearances were consistent with acute pulmonary edema (Figure 1). Following supplementary oxygen, nebulised adrenaline, parenteral corticosteroids and broad spectrum antibiotics, repeat chest radiography 9 hours later showed marked resolution of his alveolar shadowing. Computed tomographic imaging of the neck and chest showed significant subglottic stenosis (Figure 2). Subsequent magnetic resonance imaging and laryngoscopy revealed that his upper airway narrowing was a radiotherapy complication rather than recurrent malignancy. It is likely that the aspirated tablet had transiently occluded his narrow airway, resulting in type I POPE.
DISCUSSION: The differential diagnosis of hyperacute bilateral pulmonary infiltrates is wide, and includes acute respiratory distress syndrome, acute eosinophilic pneumonia, alveolar hemorrhage, chemical pneumonitis and acute pulmonary edema. Type I POPE is more commonly seen by anesthetists in patients with laryngospasm, and rarely presents as an emergency to Medicine. It is important to recognise type I POPE in the appropriate clinical context.
CONCLUSIONS: Type I POPE is a rare but important cause of noncardiogenic pulmonary edema. It should be considered in the differential diagnosis of patients presenting with acute dyspnea following transient upper airway obstruction who have radiographic appearances consistent with pulmonary edema.
Reference #1: Udeshi A, Cantie SM, Pierre E. Postobstructive pulmonary edema. Journal of Critical Care 2010;25:508.e1-508.e5.
DISCLOSURE: The following authors have nothing to disclose: Helen McGourty, Shiva Sreenivasan
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