An otherwise healthy 44 year old woman (159 cm, 54 kg) was scheduled through day surgery regimen for a hysteroscopic Noncardiogenic Pulmonary Edema from Massive Irrigation Fluid Absorption During HysteroscopicMyomectomy: A Case Report AbstractBackground: Gynecological hysteroscopy is a relatively safe procedure, used for diagnosis and treatment of intrauterine pathologies with a low percentage of complications. Some complications may be life threatening.Case presentation: An otherwise healthy 44-year-old woman presented for hysteroscopic myomectomy under spinal anesthesia. A roller pump and a morcellator -type hysteroresectoscope were used along with normal saline as the distending solution with a perfusion pressure of 100 mmHg. Within 40 minutes, she complained of chest discomfort and presented tachypnea, tachycardia, hypertension and low oxygen saturation unresponsive to bag and mask ventilation with 100% oxygen. Massive facial edema developed rapidly. Orotracheal intubation was performed and pink frothy fluid came out of the ET. Fluid overload was suspected as the most likely diagnosis and the hysteroscopy was discontinued. Laboratory findings revealed severe respiratory acidosis and hypoxemia. She was treated aggressively with positive pressure ventilation, IV bicarbonate, diuretic and inotropic perfusions. A thorax x-ray confirmed the presence of massive pulmonary edema. After a highly negative fluid balance, the respiratory parameters improved very rapidly and she was extubated in the ICU 7 hours later Discussion: Fluid overload due to absorption of irrigation fluid is seen in approximately 0, 2% of patients. Hypervolemic syndrome and hyperchloremic metabolic acidosis have been reported in NS overload. In this case, a positive fluid balance of almost 6.5 l of NS was calculated; this was not identified before due to an error in the assembly of the circuit and bypass of the alarms thus leading to non-cardiogenic pulmonary edema, anasarca, respiratory acidosis, hypocalcaemia, coagulation and hemoglobin dilution, which resolved with forced diuresis and cardiopulmonary support. She was discharged after 7 days of the procedure. Conclusion

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