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Case Reports
. 2008 Sep;24(9):e58-9.
doi: 10.1016/s0828-282x(08)70672-x.

Negative pressure pulmonary edema in the coronary care unit

Stephen A Schaffer  1 , Rizwan A Manji, Iain Kirkpatrick, Tielan Fang, Rakesh C Arora, Shelley Zieroth, Davinder S Jassal
Affiliations
Case Reports

Negative pressure pulmonary edema in the coronary care unit

Stephen A Schaffer et al. Can J Cardiol. 2008 Sep.

Abstract
in English, French

A 63-year-old woman with no known cardiac history presented with pulmonary edema accompanied by electrocardiographic evidence of ischemia. Echocardiography demonstrated normal cardiac dimensions, normal wall motion and mild diastolic dysfunction. Despite repeat attempts at extubation following aggressive diuresis, the patient required ongoing ventilatory support. Although cardiac catheterization revealed normal coronary arteries, computed tomography revealed a 4 cm 9 cm multinodular goiter extending into the mediastinum and compressing the trachea. A diagnosis of negative pressure pulmonary edema should be considered in the differential diagnosis of any patient presenting with acute heart failure.

Une femme de 63 ans ayant des antécédents cardiaques connus a consulté en raison d’un œdème pulmonaire accompagné d’observations électrocardiographiques d’ischémie. L’échocardiographie a démontré des dimensions cardiaques normales, un mouvement normal de la paroi et un léger dysfonctionnement diastolique. Malgré des tentatives répétées d’extubation après une diurèse énergique, le patient a eu besoin d’un soutien ventilatoire continu. Le cathétérisme cardiaque a révélé des artères coronaires normales, mais la tomodensitométrie a mis au jour un goitre multinodulaire de 4 cm x 9 cm se prolongeant dans le médiastin et comprimant la trachée. Il faut envisager un diagnostic d’œdème pulmonaire par pression négative dans le diagnostic différentiel d’un patient consultant à cause d’une insuffisance cardiaque aiguë.

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Figures

Figure 1)
Figure 1)
A baseline electrocardiogram demonstrating ST-T wave changes in the anterolateral leads, suggestive of ischemia
Figure 2)
Figure 2)
A chest x-ray demonstrating bilateral pulmonary vascular congestion
Figure 3)
Figure 3)
A A three-dimensional, volume-rendered image of the lungs and airway reconstructed from the chest computed tomography scan dataset demonstrates the endotracheal tube (small arrows) and its balloon (large arrow). Note that although the trachea around the tube is well seen below the balloon (arrowhead), it is not visible above the balloon. B A transverse computed tomographic image through this level shows the endotracheal tube (arrow) surrounded by a grossly enlarged thyroid (arrowheads). The thyroid has compressed the trachea against the endotracheal tube and no air is seen around it
See this image and copyright information in PMC

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