Acute Pulmonary Edema after Upper Airway Obstruction-A Case Report and Review of the Literature

Abstract

Pulmonary edema induced by upper airway obstruction is classified as a disease of noncardiogenic or unclear origin, is associated with a high rate of mortality, and is typified by the rapid onset of a resolvable disease that may arise after the upper airway obstruction has been relieved. The possible pathophysiology of this type pulmonary edema involves intrathoracic pressure alternations, hemodynamic alternations, and arterial hypoxemia. Acute pulmonary hemorrhage may occasionally be associated with pulmonary edema, due to capillary stress failure resulting from the same pathophysiology. In this report, we present our experience with a 34-year-old otherwise healthy male suffering from an upper airway obstruction caused by food allergy-aggravated angioedema. The patient was intubated because of the severe upper airway obstruction. Upon relief of the upper airway obstruction, the patient developed acute pulmonary edema and pulmonary hemorrhage. We administered mechanical ventilation and medical therapy for angioedema. His pulmonary status improved rapidly and he was extubated without further complications. He completely recovered without any sequel and was discharged from our hospital 8 days later. The total protein ratio of the lung edema fluid collected from the BAL, corrected with a dilution factor to plasma, was 5.6%. We inferred the change of hydrostatic pressure to be more predominant than the change in capillary permeability in this patient.