School of Medicine, Bahcesehir University.
Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey.
J Craniofac Surg. 2021;32(5):e421-e423. doi: 10.1097/SCS.0000000000007226.
Negative pressure pulmonary edema (NPPE) is a form of noncardiogenic pulmonary edema that typically occurs in response to an upper airway obstruction, where patients generate high negative intrathoracic pressures, leading to a pulmonary edema especially in the postoperative period. Here, we report a case of NPPE following general anesthesia that can easily be misdiagnosed as COVID-19 both radiologically and clinically during this pandemic. Twenty-year-old male was presented with sudden onset respiratory distress, tachypnea, and cyanosis just after the rhinoplasty surgery under general anesthesia. Chest radiography and thoracic computed tomography scans revealed the bilateral patchy alveolar opacities with decreased vascular clarity that looks similar to COVID-19 radiology. Negative pressure pulmonary edema is a sudden onset and life-threatening complication following general anesthesia particularly after head and neck surgery in young healthy individuals. It is a clinical condition that cannot be diagnosed unless it comes to mind. While both NPPE and COVID-19 cause hypoxemia and respiratory distress, as well as ground-glass opacities in the chest computed tomography, those opacities in NPPE appear mostly in central areas, whereas those opacities are mostly seen in peripheral areas in COVID-19. Furthermore, while NPPE cause decreased vascular clarity, COVID-19 causes vascular dilatations in the areas of opacities. Those differences together with medical history of the patient is crucial to differentiate these 2 similar identities. Negative pressure pulmonary edema requires an immediate recognition and intervention, therefore, we would like to raise the awareness of clinicians for such condition to avoid possible mistakes during the pandemic situation.
负压性肺水肿（NPPE）是一种非心源性肺水肿，通常发生在上呼吸道阻塞时，患者会产生高负压胸腔内压，导致肺水肿，尤其是在术后。在这里，我们报告了一例全麻后 NPPE 病例，在大流行期间，该病例在影像学和临床方面都容易误诊为 COVID-19。一名 20 岁男性在全身麻醉下接受鼻整形手术后突然出现呼吸急促、呼吸急促和发绀。胸部 X 线摄影和胸部计算机断层扫描显示双侧斑片状肺泡混浊，血管清晰度降低，与 COVID-19 放射学相似。负压性肺水肿是全麻后特别是头颈部手术后年轻健康个体突然发生的危及生命的并发症。除非想到它，否则不能诊断这种临床状况。虽然 NPPE 和 COVID-19 都会导致低氧血症和呼吸窘迫，以及胸部计算机断层扫描中的磨玻璃混浊，但 NPPE 的混浊主要出现在中央区域，而 COVID-19 的混浊主要出现在周边区域。此外，虽然 NPPE 导致血管清晰度降低，但 COVID-19 导致混浊区域的血管扩张。这些差异以及患者的病史对于区分这两种相似的病症至关重要。负压性肺水肿需要立即识别和干预，因此，我们希望提高临床医生对这种情况的认识，以避免大流行期间可能出现的错误。
