Abstract
Negative pressure pulmonary edema (NPPE) is a rare, potentially life-threatening, and yet diagnostically challenging perioperative complication. Most cases of NPPE occur in the context of anesthetic procedures, mainly caused by upper airway obstruction, and are diagnosed during the recovery period. We present a case of fulminant NPPE in a patient during general anesthesia which illustrates the eye-catching CT findings that can occur in NPPE and eventually support diagnosis. With regard to the current pandemic, we include a discussion of the typical imaging patterns of COVID-19 as a radiological differential diagnosis of NPPE. A 42-year old male patient presented with sudden respiratory insufficiency during arthroscopic knee lavage and subsequently required highly invasive ventilation therapy and catecholamine administration. Postoperative CT imaging of the thorax exhibited extensive, centrally accentuated consolidations with surrounding ground-glass opacity in all lung lobes, suggestive of pulmonary edema. In view of the clinical course and the imaging findings, a negative pressure pulmonary edema (NPPE) was diagnosed.
Highlights
Ventilation therapy was initially performed with an oxygen fraction of
Upon arrival in the ICU (5 h after anesthesia induction), ventilation therapy was performed with an oxygen fraction of 50%, positive end-expiratory pressure (PEEP) = 10, Pinsp = 36, and respiratory rate (RR) = 24
The patient was transferred to general ward after 6 days in the ICU
Summary
Diagnostics 2020, 10, x FOR PEER REVIEW Days later, hospitalization the patient developed an acute onset of knee pain and fever. Ventilation therapy was initially performed with an oxygen fraction of After airway management and before incision, a respiratory decompensation with global insufficiency occurred and a highly invasive ventilation therapy was necessary, with an oxygen fraction of 100%, PEEP
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