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[与上呼吸道梗阻相关的负压性肺水肿和出血]

[Negative-pressure pulmonary edema and hemorrhage associated with upper airway obstruction].

作者信息

Mussi Ricardo Kalaf, Toro Ivan Felizardo Contrera

机构信息

Universidade Estadual de Campinas, Campinas, SP, Brasil.

出版信息

J Bras Pneumol. 2008 Jun;34(6):420-4. doi: 10.1590/s1806-37132008000600013.

Abstract

Negative-pressure pulmonary edema accompanied by hemorrhage as a manifestation of upper airway obstruction is an uncommon problem that is potentially life-threatening. The principal pathophysiological mechanism involved is the generation of markedly negative intrathoracic pressure, which leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. We report the case of an adult male with diffuse alveolar hemorrhage following acute upper airway obstruction caused by the formation of a cervical and mediastinal abscess resulting from the insertion of a metallic tracheal stent. The patient was treated through drainage of the abscess, antibiotic therapy, and positive pressure mechanical ventilation. This article emphasizes the importance of including this entity in the differential diagnosis of acute lung injury after procedures involving upper airway instrumentation.

摘要

负压性肺水肿伴出血作为上气道梗阻的一种表现是一个罕见但可能危及生命的问题。主要涉及的病理生理机制是胸内压显著降低,这导致肺血管容量增加和肺毛细血管跨壁压升高,从而产生肺泡-毛细血管膜破裂的风险。我们报告一例成年男性病例,该患者因金属气管支架置入后形成颈部及纵隔脓肿导致急性上气道梗阻,继而出现弥漫性肺泡出血。患者通过脓肿引流、抗生素治疗及正压机械通气进行治疗。本文强调在涉及上气道器械操作后的急性肺损伤鉴别诊断中纳入该病症的重要性。

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