Postobstructive pulmonary edema after biopsy of a nasopharyngeal mass.

نویسندگان

Keyur Kamlesh Mehta

Sabina Qureshi Ahmad

Vikas Shah

Haesoon Lee

چکیده

We describe a case of 17 year-old male with a nasopharyngeal rhabdomyosarcoma who developed postobstructive pulmonary edema (POPE) after removing the endotracheal tube following biopsy. He developed muffled voice, rhinorrhea, dysphagia, odynophagia, and difficulty breathing through nose and weight loss of 20 pounds in the preceding 2 months. A nasopharyngoscopy revealed a fleshy nasopharyngeal mass compressing the soft and hard palate. Head and neck MRI revealed a large mass in the nasopharynx extending into the bilateral choana and oropharynx. Biopsy of the mass was taken under general anesthesia with endotracheal intubation. Immediately after extubation he developed oxygen desaturation, which did not improve with bag mask ventilation with 100% of oxygen, but improved after a dose of succinylcholine. He was re-intubated and pink, frothy fluid was suctioned from the endotracheal tube. Chest radiograph (CXR) was suggestive of an acute pulmonary edema. He improved with mechanical ventilation and intravenous furosemide. His pulmonary edema resolved over the next 24 h. POPE is a rare but serious complication associated with upper airway obstruction. The pathophysiology of POPE involves hemodynamic changes occurring in the lung and the heart during forceful inspiration against a closed airway due to an acute or chronic airway obstruction. This case illustrates the importance of considering the development of POPE with general anesthesia, laryngospasm and removal of endotracheal tube to make prompt diagnosis and to initiate appropriate management.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Croup-induced postobstructive pulmonary edema.

Postobstructive pulmonary edema is life-threatening, and results from a sudden episode of upper airway obstruction. Croup is generally thought to be a benign condition, but occasionally it can develop into postobstructive pulmonary edema. We present a case of a 5-year-old boy with recurrent croup, who was diagnosed with postobstructive pulmonary edema. Our experience alerts pediatricians to thi...

متن کامل

Postobstructive pulmonary edema following accidental near-hanging

PATIENT Female, 14 FINAL DIAGNOSIS: Postobstructive pulmonary edenma Symptoms: Chest indrawing • bilateral pulmonary crepitations • tachypnea MEDICATION - Clinical Procedure: Controlled ventilatory support • positive end expiratory pressure Specialty: Intensive care. OBJECTIVE Unusual clinical course. BACKGROUND Postobstructive pulmonary edema (POPE) is a life-threatening complication tha...

متن کامل

Postobstructive pulmonary edema following hanging: a misnomer.

DOI: 10.4103/0019-5359.49220 Postobstructive pulmonary edema (POPE) i s an uncommon bu t we l l -descr ibed complication of upper airway obstruction. [1-2] Two forms of POPE have been deÞ ned: POPE I is associated with sudden, severe upper airway obstruction, whereas POPE II follows surgical relief of chronic upper airway obstruction.[2] Among the numerous causes of POPE I Þ gures hanging.[2] H...

متن کامل

Negative-Pressure Pulmonary Edema.

Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstit...

متن کامل