Postobstructive Pulmonary Edema that Developed Immediately after the Removal of an Endobronchial Foreign Body

Abstract

The patient was a 5-year-old boy who was transported to our hospital for a paroxysmal cough, disturbance of consciousness, tonic-clonic convulsions and labored breathing. The patient's respiratory failure persisted after the convulsions remitted, and the presence of an endobronchial foreign body was suspected based on the findings of chest CT performed the following day. A peanut was subsequently removed from the right main bronchus using a bronchoscope with tracheal intubation and bag valve mask ventilation. Immediately after removal, the patient rapidly developed exacerbated hypoxemia, and a reduction in right lung lucency was noted on chest radiography. He was therefore diagnosed with type II postobstructive pulmonary edema, and his condition improved within a short period of time.

A rare case of type II negative pressure pulmonary edema following extraction of inhaled peanuts in a 21-month-old boy

“…The final diagnosis of type II NPPE was made in our patient with the support of chest radiographic findings as reported in all previous cases in the literature. [15][16][17][18][19] Notably, a chest X-ray also showed patchy opacification in the left upper zone in the present case, but the mechanism behind this phenomenon remains unknown.…”

“…Masuda et al 18 observed that most of the opacification in the lungs disappeared in less than 1 hour after treatment as shown by chest radiograms. Moser et al 15 reported that complete resolution of pulmonary edema was achieved 37 hours after treatment with ventilation and diuretics in a 14-year-old girl.…”

“…3 Only five reports of cases of pediatric type II NPPE that described its diagnosis and treatment have been documented in the last two decades. [15][16][17][18][19] Most of these cases occurred after tonsillectomy/adenoidectomy. 15,16,19 Only one case was reported to be caused by the removal of a foreign body in the bronchus.…”

“…[15][16][17][18][19] Approximately half of the patients, including our patient, received diuretics 15,16,19 and corticosteroids. 16,18 Because of the limited amount of studies, the effect of diuretics and corticosteroids in managing type II NPPE in children remains unknown. Determination of this issue will be challenging because of the rarity of type II NPPE.…”

“…[15][16][17][18][19] To date, only one case of type II NPPE caused by the removal of an endobronchial foreign body in a child has been reported. 18 We present another case of type II NPPE that developed after extraction of inhaled peanuts in a 21-month-old boy.…”