Negative pressure pulmonary edema

摘要

A 26-year-old woman presented to the emergency department with progressive dyspnea for 1 day. She had no medical history such as hypertension and diabetes mellitus, and she denied fever, chest pain, cough, sputum, hemoptysis, and aspiration. On arrival, she became cyanotic and the SpO_2 was 68% on ambient air. Immediate intubation was done for acute hyp-oxic respiratory failure, and no purulent secretion or blood was found while suction through the endotracheal tube. A chest radiograph obtained after intubation showed a mediastinal mass and infiltrates over the left lung field (Figure 1). An electrocardiogram and an echocardiogram appeared normal, and cardiac enzyme levels were within the normal range. Computed tomography of the chest disclosed severe airway stenosis from trachea to bilateral main bronchus (arrows), which is compressed by a huge mass over the anterior mediastinum (asterisk) (Figure 2A) and diffuse homogeneous infiltrations over the left lung field (Figure 2B). Two days later, debulking surgery of the anterior mediastinal tumor was performed for relieving the obstruction of the airway. Follow-up of chest radiography showed resolution of left infiltrations, and extubation was smoothly done 1 week later.