Unmasking Negative Pressure Pulmonary Edema Following Hanging: A Case Series

Abstract

Pulmonary edema is a rare mechanism of death that develops after partial hanging, a potential complication that physicians should consider early in the management of these patients. This case series discusses the presentation, evaluation, and treatment course of three patients who had attempted suicide by hanging and were admitted to the hospital. These patients were admitted to the intensive care unit after being stabilized and supportive treatment was provided. In all the cases, a radiological scan of the chest revealed diffuse infiltrates consistent with pulmonary edema on both sides, features of which were also noted during a diagnostic bronchoscopy. After providing the best intensive care in the hospital, two patients clinically improved, and one patient succumbed to cardiac arrest. As most patients will be brought dead to the hospital following hanging, negative pressure pulmonary edema remains underdiagnosed. Thus, this case series enumerates the possible etiologies of negative pressure pulmonary edema and its contribution to death following suicidal hanging.

Keywords: acute respiratory distress syndrome (ards); flexible fiberoptic bronchoscopy (ffb); hanging; negative-pressure pulmonary edema; post obstructive pulmonary edema; steroids and diuretics; suicide death; suicide mortality.

Figure 1. A) Chest radiograph revealed bilateral diffuse infiltrates (left>right) with hilar prominence. B) Flexible bronchoscopy revealed frothy blood flooding until the bilateral mainstem bronchi with airway congestion. C) Chest radiograph revealed bilateral subcutaneous emphysema (left>right) with cephalization of vasculature and persistent pulmonary infiltrates. D) Post-mortem showed frothy secretions from the lungs.

Figure 2. A) Chest radiograph revealed an enlarged cardiac silhouette with bilateral diffuse infiltrates. B) Flexible bronchoscopy revealed frothy secretions flooding the bilateral mainstem bronchi. C) Resolution of pulmonary edema in chest radiograph.

Figure 3. A) Chest radiograph revealed bilateral diffuse infiltrates. B) Flexible bronchoscopy revealed frothy secretions. C) Resolution of pulmonary edema in chest radiograph.