Jo Yumin, Hwang Jagyung, Lee Jieun, Kang Hansol, Hong Boohwi
Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
Department of Anesthesiology and Pain Medicine, Daejeon Woori Hospital, Daejeon, South Korea.
J Med Case Rep. 2021 Mar 16;15(1):137. doi: 10.1186/s13256-021-02697-6.
Diffuse alveolar hemorrhage (DAH) is a rare, life-threatening condition that can present as a spectrum of nonspecific symptoms, ranging from cough, dyspnea, and hemoptysis to severe hypoxemic respiratory failure. Perioperative DAH is frequently caused by negative pressure pulmonary edema resulting from acute airway obstruction, such as laryngospasm, although hemorrhage itself is rare.
This case report describes an unexpected hemoptysis following monitored anesthesia care for vertebroplasty. A 68-year-old Asian woman, with a compression fracture of the third lumbar vertebra was admitted for vertebroplasty. There were no noticeable events during the procedure. After the procedure, the patient was transferred to the postanesthesia care unit (PACU), at which sudden hemoptysis occurred. The suspected airway obstruction may have developed during transfer or immediate arrive in PACU. In postoperative chest x-ray, newly formed perihilar consolidation observed in both lung fields. The patients was transferred to a tertiary medical institution for further evaluation. She diagnosed with DAH for hemoptysis, new pulmonary infiltrates on chest x-ray and anemia. The patient received supportive care and discharged without further events.
Short duration of airway obstruction may cause DAH, it should be considered in the differential diagnosis of postoperative hemoptysis of unknown etiology.
弥漫性肺泡出血（DAH）是一种罕见的、危及生命的疾病，可表现为一系列非特异性症状，从咳嗽、呼吸困难、咯血到严重的低氧性呼吸衰竭。围手术期DAH常由急性气道梗阻（如喉痉挛）导致的负压性肺水肿引起，尽管出血本身很少见。
本病例报告描述了椎体成形术监护麻醉后意外出现咯血的情况。一名68岁的亚洲女性，因第三腰椎压缩性骨折入院接受椎体成形术。手术过程中未发生明显事件。术后，患者被转入麻醉后监护病房（PACU），随后突然出现咯血。疑似气道梗阻可能在转运过程中或刚到达PACU时发生。术后胸部X线检查显示双肺野出现新形成的肺门周围实变。患者被转至三级医疗机构进行进一步评估。她因咯血、胸部X线出现新的肺部浸润及贫血被诊断为DAH。患者接受了支持治疗，出院时未再出现其他情况。
短时间的气道梗阻可能导致DAH，在病因不明的术后咯血鉴别诊断中应考虑到这一点。
