Pulmonary Edema Secondary to Dynamic Tracheal Collapse

Abstract

Severe pulmonary edema can be a complication of both intra- and extrathoracic airway obstructions. We describe a unique case of pulmonary edema following expiratory dynamic collapse of the trachea. An 80-year-old woman presented with orthopnea associated with a forcible dry cough for about a week. Physical examination revealed bilateral diffuse lung crepitations. Chest radiography demonstrated bilateral pulmonary edema. However, an echocardiogram demonstrated normal biventricular size and function. Spiral CT of the chest was negative for pulmonary embolism; however, it demonstrated expiratory collapse of the posterior tracheal wall. Dynamic CT of the trachea and bronchoscopy subsequently confirmed such findings. Different cough suppressants and diuretics were tried, but with limited improvement in the patient's respiratory status. A tracheal stent was placed to support the collapsed trachea. Both the clinical and radiologic manifestations of the postobstructive pulmonary edema resolved subsequently. Pulmonary function tests done before and 3 months after stent placement demonstrated an improvement in both FEV1 and FVC. There was no recurrence of patient symptoms 3 years later. Airway obstructions should be considered in the workup of non-cardiogenic pulmonary edema. Tracheal stenting can be effective in the resolution of such edema in select patients.