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Weekly Chest CasesArchive of Old Cases

Case No : 532 Date 2008-01-07

  • Courtesy of Hye-Jeong Lee, MD, Byoung Wook Choi, MD, Ji Eun Nam, MD, Jin Hur, MD, Kyu Ok Choe, MD. / Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Korea.
  • Age/Sex 52 / F
  • Chief ComplaintKnown benign thyroid mass, Dyspnea for 3 days, Aggravation of dyspnea 3 hours after admission (oxygen saturation 58%)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Postobstructive pulmonary edema (POPE) or negative pressure pulmonary edema (NPPE)
Radiologic Findings
Figure 1 : Neck CT shows a large mass that compresses the trachea
Figure 2 : Initial chest radiography is normal
Figure 3 : Follow-up chest radiograph 3 hours after admission shows extensive bilateral pulmonary infiltrates, considered to be postobstructive pulmonary edema
Figure 4 : Follow-up chest radiogrpah 2 days after admission care shows improvement of the pulmonary infiltrations
Brief Review
Postobstructive pulmonary edema (POPE) is a well-known condition to anesthesiologists but is not familiar to general clinicians. POPE follows upper airway obstruction due to laryngospasm, epiglottitis or tumor. The forceful respiratory effort required against an obstructed airway in patients with these conditions leads to extremely negative intrathoracic pressure, and a subsequent increase in venous return and transudation from the capillary bed. A sudden relief of chronic upper airway obstruction, such as adeno-tonsillar hypertrophy, also causes POPE due to a sudden drop in airway pressure. The treatment of POPE is resuscitation with oxygen supplement, mechanical ventilation if necessary and specific treatment of the underlying condition. The prognosis of POPE is generally good but potentially life-threatening, therefore early recognition and appropriate therapy for the underlying etiologies is important.
References
1. Koh MS, Hsu AA, Eng P. Negative pressure pulmonary oedema in the medical intensive care unit. Intensive Care Med 2003; 29 (9):1601-4.
2. Butterell H, Riley RH. Life-threatening pulmonary oedema secondary to tracheal compression. Anaesth Intensive Care 2002; 30 (6):804-6.
3. Deepika K, Kenaan CA, Barrocas AM, Fonseca JJ, Bikazi GB. Negative pressure pulmonary edema after acute upper airway obstruction. J Clin Anesth 1997; 9(5) :403-8.
4. Guffin TN, Har-el G, Sanders A, Lucente FE, Nash M. Acute postobstructive pulmonary edema. Otolaryngol Head Neck Surg 1995;112(2) :235-7.
5. Louis PJ, Fernandes R. Negative pressure pulmonary edema. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93(1): 4-6.
Keywords
Lung, Edema,

No. of Applicants : 53

▶ Correct Answer : 29/53,  54.7%
  • - KAUMS, Kashan, Iran Ebrahim Razi
  • - Department of Diseases of the Thorax, Ospedale GB Morgagni, Italy Venerino Poletti
  • - E-Da Hospital, Taiwan Yu-Feng Wei
  • - Maimonides Medical Center; Brooklyn, N.Y., U.S.A. Naomi Twersky
  • - Pittwater Radiology, Australia Julie Arora
  • - Armidale Radiology, Australia Saurabh Khandelwal
  • - Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - New Title of Affiliation is China Medical University, Taiwan Jun-Jun Yeh
  • - Gimpo Woori Hospital, Korea Son Youl Lee
  • - CHRU Lille hopital calmette, France Toledano Manuel
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
  • - Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
  • - Good gang-an hospital, Korea Kyung Hwa Jung
  • - Dongguk University International Hospital, Korea Hee Seok Choi
  • - Yonsei University college of medicine Severance hospital, Seoul, Korea Hua Sun Kim
  • - Mokpo Hankook Hospital, Korea Sang Uk Park
  • - Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
  • - Homs National Hospital, Homs - Syria Rami Abou Zalaf
  • - EKH-Berlin, Germany Michael Weber
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - Annecy hospital, France Gilles Genin
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - Riverside Radiology Associates, Columbus, Ohio, USA Sumit Seth
  • - Jackson Memorial Hospital, Miami, Florida, USA N.B.S. Mani
  • - Shinsegye Rad Clinic, Daegu, Korea Gi Beom Kim
  • - Nassau, Bahamas Trupti Dabholkar
  • - CHU Grenoble, France Bing Fabrice
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
▶ Semi-Correct Answer : 19/53,  35.8%
  • - Registrar in Radiology, UHL NHS Trust, UK. A. Donuru
  • - Sri Ravi Nursing Home ,Kazipet, India Pavankumar Vodithala
  • - Shiga University of Medical, Japan Norihisa Nitta
  • - Pulmonologist, Medical College Chest Hospital, Thrissur, India Raveendran T.K
  • - Lilavati Hospital & Rsearch Centre, Mumbai, India Mahavir Swami
  • - Pancham MRI Bareilly, India Praveen Kumar
  • - Anandnagar, Hingne Khurd, Pune, India Bankim J. Amin
  • - Oswal Cancer Hospital, Ludhiana, Punjab, India Lovkesh Mittal
  • - Medinova Diagnostics, Bheemavaram, AP., India Harsha Vardhan
  • - Inha University Hospital, Korea Yoon mi Lee
  • - Regional Imaging Riverina, Australia Rashid Hashmi
  • - Nour El-Islam Radiology Center, Alexandria, Egypt Elsayed Mousa
  • - India Shiva Rastogi
  • - University of Virginia, USA Rachita Khot
  • - IRSA La Rochelle, France Jean-Luc BIGOT
  • - Vital imaging centre, Mumbai, India Ganesh Agrawal
  • - Ultra Care Coimbatore, India Debabrata Das
  • - Ryby hall clinic Pune, India Sudarshan Rawat
  • - Max Hospital, New Delhi, India Vickrant Malhotra
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