Acute post-tonsillectomy negative pressure pulmonary edema

197 oropharynx to the rectum, and the duodenum is most frequently affected, followed by the stomach, esophagus and colon (1,2). Kaposi's sarcoma is about 300 times more common in AIDS patients than in those with other immunodeficiency types, and generally occurs in the setting of CD4 count below 150–200 cells/ mm 3(1). The diagnosis is made by means of digestive endoscopy and biopsy. The classical endoscopic finding is represented by subepi-thelial, reddish, ulcerative or non-ulcerative lesions (3). Barium studies characterize polypoid lesions with smooth contour with sizes ranging from few millimeters to 3 cm. Larger lesions may ulcerate, giving the lesion a " bullseye " or " target " pattern (4). Computed tomography detects subepithelial polypoid lesions or irregular thickening of gastric folds, which after intravenous contrast injection show hypervascular behavior, with a more marked enhancement than that of the adjacent mucosa in the arterial phase due to the intense vascularization of the tumor. Additionally , peripancreatic lymph node enlargement may be observed in the porta hepatis, mesenterium and retroperitoneum in up 80% of cases (1,3). Kaposi's sarcoma with visceral involvement is frequently associated with poor prognosis. The treatment includes antiretroviral therapy, radiotherapy, and chemotherapy (5). The authors conclude that Kaposi's sarcoma should be considered in the differential diagnosis of hypervascular submucosal lesions, particularly in AIDS patients. Acute post-tonsillectomy negative pressure pulmonary edema Edema pulmonar agudo por pressão negativa pós-tonsilectomia A female, 28-year patient was submitted to tonsillectomy and developed respiratory discomfort immediately after the procedure. At the following day, posteroanterior and lateral chest radiography demonstrated coalescent, poorly defined opacities in both lungs, sparing the periphery and characterizing the so called " butterfly wing " pattern, compatible with a diffuse alveolar process. The cardiac image was normal (Figure 1A). Three days after the procedure , without any use of medication, radiographic images (same views) revealed the opacities disappearance (Figure 1B). Negative pressure pulmonary edema (NPPE) represents a rare occurrence in surgeries (0.094%), most frequently reported in buccomaxillary-facial and oral surgeries due to the probability of upper airway obstruction (1–3). This condition is divided into two classes, namely, type I NPPE caused by upper airway obstruction such as, for example, post-tracheal extubation laryngospasm, epiglotiditis, tracheal cannula obstruction and postoperative vocal cord paralysis (3–6). Type II NPPE occurs after corrective surgical procedures for chronic airway obstruction such as tonsillar hyperplasia, sleep apnea, tumors and acromegaly (7,8). In such cases, the treatment should …