Negative pressure pulmonary edema-related diffuse alveolar hemorrhage associated with Sevoflurane and cigarette smoking

Abstract

Negative-pressure pulmonary edema (NPPE)-related diffuse alveolar hemorrhage (DAH) is an underdiagnosed clinical entity seen with alveolar capillary damage. The pathophysiology of type I NPPE is generation of a negative pleural pressure against an upper airway obstruction. We suspect this process was facilitated by preexisting alveolar damage with smoking and administration of the irritating and coagulopathic inhaled anesthetic sevoflurane. We present a case of a healthy 31-year-old man who developed postoperative hemoptysis, diffuse ground-glass opacity and infiltrates on computed tomography (CT) of the chest, anemia, and hypoxic respiratory failure. A diagnosis of DAH was made and a serologic workup for systemic disorders including vasculitis and connective tissue diseases was negative. The patient rapidly improved with supportive care and had complete resolution of his bilateral infiltrates on repeat chest x-ray two weeks later. Our literature review identified three cases of DAH in the setting of sevoflurane administration. Our case illustrates the importance of including NPPE-related DAH on the differential of post-operative hemoptysis, especially in association with sevoflurane administration and a history of cigarette smoking.

Cannabis-Related Diffuse Alveolar Hemorrhage in a 16-Year-Old Patient: A Case Report

“…This is a well-recognized post-operative clinical entity which has been described as causative factor of DAH. Generation of a negative pleural pressure on inspiration against an upper airway obstruction is the mechanism of stress failure of the alveolar-capillary membrane in NPPE (22). In our case, we did not observe airway obstruction during general anesthesia and the surgery was conducted without any complications.…”

Negative-pressure pulmonary Hemorrhaging Due to Severe Obstructive Sleep Apnea

“…In addition, pulmonary hemorrhaging associated with NPPE, called negative-pressure pulmonary hemorrhaging (NPPH), also occurs very rarely ( 1 , 9 - 11 ). The etiology of NPPH is thought to be stress failure, which is the mechanical disruption of the alveolar-capillary membrane due to high negative intrathoracic pressure ( 1 , 12 ).…”

Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report

“…Diffuse alveolar hemorrhage (DAH) is characterized by damage to the alveolar microvessels and accumulation of red blood cells in the alveoli. DAH is a syndrome in which respiratory failure occurs due to hemoptysis, anemia, and hypoxemia[ 1 , 2 ]. Pulmonary imaging may be important in the diagnosis.…”