Pulmonary oedema following choking: report of two cases

Abstract

Two children, aged 3 1/2 and 5 1/2 years, are described. Both developed pulmonary oedema (PE) following a short episode of choking on a sweet and an orange, respectively. On admission diagnosis was made by chest X-ray. One child was asymptomatic despite PE while the other showed only mild respiratory distress. Both children recovered spontaneously and chest X-rays showed a return to normal within 24 h. The mechanism of PE production is discussed. It is suggested that oedema formation occurs during the obstruction and that it is due to hypoxia and the severe negative pleural pressure resulting from attempts to inspire against the obstructed airway. both hypoxia and severe negative pleural pressure cause an increase in pulmonary capillary pressure and transduration of fluid across the capillary membrane.

Life–threatening Pulmonary Oedema Secondary to Tracheal Compression

“…Other causes of upper airway obstruction leading to post-obstructive pulmonary oedema have also been highlighted by numerous reports. These include euthyriod goitre in pregnancy 6 , rheumatoid arthritis 7 , Hodgkin's disease 8 , near strangulation 9 , choking 10 , other ENT conditions 11 and biting the endotracheal tube 12 .…”

Negative pressure pulmonary edema in children – pathogenesis and clinical management

“…In children, NPPE has been described in association with upper airway infections resulting in airway obstruction (e.g. epiglottis, croup), postextubation laryngeal edema, tracheal or airway obstruction caused by airway secretions or foreign bodies, near strangulation and choking, relief of chronic airway obstruction as seen following tonsillectomy and adenoidectomy, use of neuromuscular blocking agents for tracheal intubation, following the use of vigorous suction during bronchoscopy and lung re‐expansion following drainage of the pleural effusion or pneumothorax (5,6,12–17). Recently, NPPE was been described in an adult with acute lung injury receiving mechanical ventilation with a low tidal volume strategy, using the volume control mode of ventilation.…”