Negative pressure pulmonary edema after nasal fracture reduction in an obese female patient: a case report

Abstract

Postoperative negative pressure pulmonary edema (NPPE) is a rare, but well-known life-threatening complication of acute upper airway obstruction (UAO) which develops after general anesthesia. The pronounced inspiratory efforts following UAO lead to excessive negative inspiratory pressure, which may cause acute pulmonary edema. Early recognition and prompt treatment of NPPE is necessary to prevent patient morbidity and mortality. In addition, the physician should carefully manage the patient who has risk factors of UAO to prevent this situation. We experienced a case of NPPE following laryngospasm after tracheal extubation in an obese patient who underwent open reduction of orbital wall and nasal bone surgery.

Keywords: airway obstruction; laryngospasm; nasal surgery; negative pressure pulmonary edema; obese.

Figure 1

Ten minutes after re-intubation chest X-ray showed diffuse interstitial and alveolar infiltrates in bilateral centralized areas (white arrows).

Figure 2

Chest computed tomography scan at the first postoperative day revealed interlobular septal wall thickening and patchy ground glass opacity in the bilateral upper lungs, consistent with NPPE (white arrows). Abbreviation: NPPE, negative pressure pulmonary edema.

Figure 3

Plain chest X-ray at the third postoperative day showed the resolution of pulmonary edema.