Abstract
BackgroundDiffuse 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 presentationThis 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.ConclusionsShort duration of airway obstruction may cause DAH, it should be considered in the differential diagnosis of postoperative hemoptysis of unknown etiology.
Highlights
Hemoptysis immediate after non-airway surgery is very disconcerted, and quick identification of cause is important
Short duration of airway obstruction may cause Diffuse alveolar hemorrhage (DAH), it should be considered in the differential diagnosis of postoperative hemoptysis of unknown etiology
Diffuse alveolar hemorrhage (DAH) with macroscopic hemoptysis is a rare but life threatening condition characterized by the accumulation within the alveoli of red blood cells arising from the alveolar capillaries
Summary
Hemoptysis immediate after non-airway surgery is very disconcerted, and quick identification of cause is important. Case A 68-year-old Asian woman, 145 cm in height and 45 kg in weight, with a compression fracture of the third lumbar vertebra was admitted for vertebroplasty. Her previous medical history included osteoporosis, and her previous surgical history included appendectomy, removal of a thyroid nodule, and recent repair of the right rotator cuff under general anesthesia. In the postoperative chest x-ray taken immediately afterwards, newly formed perihilar consolidation and air bronchograms which were not present in the preoperative radiograph images were observed in both lung fields (Fig. 1). The vital signs at the time of transfer were stable; body temperature of 36.8 °C, pulse rate 82 beats/min, respiration 20/min, and blood pressure 120 / 75 mmHg. The oxygen saturation was 97%. The patient requested an outpatient clinic follow up, but did not visit until 6 months of discharge
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