Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period

Han, In Soo; Han, Bo Mi; Jung, Soo Yeon; Yoon, Jun Rho; Chung, Eun Yong

doi:10.4266/acc.2016.00689

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…There have been several reports of NPPH in the perioperative period, triggered by laryngospasm after extubation 3) . In Japan, only a few other cases of choking due to food aspiration and sleep apnea have been reported 6,7) .…”

Section: Discussionmentioning

confidence: 99%

“…However, negative pressure pulmonary hemorrhage (NPPH), which is caused by excessive negative pressure in the thoracic cavity, is another differential disease for acute respiratory exacerbation. NPPH is caused by upper airway obstruction, particularly triggered by laryngospasm after extubation in the perioperative period 3) . However, there have been no reports of NPPH caused by laryngospasm without an obvious invasive factor.…”

Section: Introductionmentioning

confidence: 99%

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Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report

Yamaki,

Ejima,

Sato

et al. 2023

Respiratory Endoscopy

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Alveolar hemorrhage may occur during an acute exacerbation of interstitial lung disease (AE-ILD) or may be caused by a negative pressure mechanism due to upper airway obstruction such as laryngospasm in the perioperative period. There have been no reports of negative pressure pulmonary hemorrhage (NPPH) due to laryngospasm without obvious invasive factors. We experienced a case of repeated NPPH due to idiopathic laryngospasm, resembling an AE-ILD. A 62-year-old woman developed multiple alveolar hemorrhages due to a sense of obstruction in the throat, followed by bloody sputum and dyspnea. She was considered to have an AE-ILD with Sjögren's syndrome and was treated with immunosuppressive therapy but had recurrent relapses. Bronchoscopy was performed under minimal anesthesia to elicit the cough reflex by vocal cord stimulation, and findings of internal rotation and complete occlusion of the vocal cords were confirmed. She was diagnosed as NPPH due to laryngospasm, and she has been treated with muscle relaxants without recurrence. NPPH due to laryngospasm can be a differential diagnosis as a cause of alveolar hemorrhage. By confirming the diagnosis through bronchoscopic examination of the larynx under minimal anesthesia, unnecessary immunosuppressive treatment for suspected AE-ILD can be avoided and appropriate preventive treatment can be provided.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report

Yamaki,

Ejima,

Sato

et al. 2023

Respiratory Endoscopy

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“…It is thought that a more detailed examination is needed to determine whether this mild mitral regurgitation was the cause of unilateral DAH in this case, but such an examination was not performed in this patient. In 2016, Han et al [ 10 ] reported negative pressure pulmonary hemorrhage that occurred after laryngospasm in the postoperative period. In 2016, Choe et al [ 11 ] reported DAH after transfemoral cerebral angiography in patients taking clopidogrel, and there is a potential for DAH associated with neuro-intervention in patients with hemoptysis and respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

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

Park

Woo

et al. 2021

WJCC

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BACKGROUND Unilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations. Negative pressure in the lungs is created, resulting in negative pressure pulmonary edema (NPPE). CASE SUMMARY A 78-year-old male patient diagnosed with spinal stenosis was admitted to receive a unilateral laminectomy with bilateral decompression. The patient had been diagnosed with hypertension four years earlier and asthma more than 70 years earlier. We experienced a unilateral alveolar hemorrhage associated with NPPE that occurred in a longstanding asthma patient who bit the intubated endotracheal tube for a short period during posture change at the end of surgery. Because diffuse alveolar hemorrhage accompanied by NPPE was caused in this case by airway obstruction in an older patient with asthma without known risk factors, anesthesiologists should be careful not to induce airway irritation during anesthesia awakening in asthma patients. CONCLUSION Because diffuse alveolar hemorrhage accompanied by NPPE can occur, anesthesiologists should take care not to induce airway irritation.

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“…A typical perioperative condition is laryngospasm, which occurs after extubation of an endotracheal tube. [ 9 , 10 ] Other conditions may include biting of the endotracheal tube or the laryngeal mask. [ 11 , 12 ] Although most patients experience negative pressure pulmonary edema, hemorrhages can develop in the alveoli, and the destruction of pulmonary capillaries plays an important role in overt pulmonary hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report

Hwang²,

Lee

et al. 2021

J Med Case Reports

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Background Diffuse alveolar hemorrhage (DAH) is a rare, life-threatening condition that can present as a spectrum of nonspecific symptoms, ranging from cough, dyspnea, and hemoptysis to severe hypoxemic respiratory failure. Perioperative DAH is frequently caused by negative pressure pulmonary edema resulting from acute airway obstruction, such as laryngospasm, although hemorrhage itself is rare. Case presentation This case report describes an unexpected hemoptysis following monitored anesthesia care for vertebroplasty. A 68-year-old Asian woman, with a compression fracture of the third lumbar vertebra was admitted for vertebroplasty. There were no noticeable events during the procedure. After the procedure, the patient was transferred to the postanesthesia care unit (PACU), at which sudden hemoptysis occurred. The suspected airway obstruction may have developed during transfer or immediate arrive in PACU. In postoperative chest x-ray, newly formed perihilar consolidation observed in both lung fields. The patients was transferred to a tertiary medical institution for further evaluation. She diagnosed with DAH for hemoptysis, new pulmonary infiltrates on chest x-ray and anemia. The patient received supportive care and discharged without further events. Conclusions Short duration of airway obstruction may cause DAH, it should be considered in the differential diagnosis of postoperative hemoptysis of unknown etiology.

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Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period

Cited by 7 publications

References 16 publications

Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report

Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report

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

Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report

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