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Yiu D, Stephens C, McCullough J, Osborn L. A Case Report of Anesthesia-induced Diffuse Alveolar Hemorrhage Presenting to the Emergency Department. Clin Pract Cases Emerg Med 2023; 7:227-229. [PMID: 38353189 PMCID: PMC10855281 DOI: 10.5811/cpcem.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 02/18/2024] Open
Abstract
Introduction The inhaled anesthetic sevoflurane is an uncommon etiology of diffuse alveolar hemorrhage (DAH). As DAH typically presents in the inpatient, postoperative setting, it has been infrequently reported in the anesthesiology literature and, to our knowledge, has not been reported in the emergency medicine literature to date. Case Report We describe the presentation of a young, healthy male in respiratory distress to a busy urban emergency department (ED) after an outpatient surgical procedure. We highlight the etiology of post-anesthesia DAH and the acute management of this rare diagnosis in the ED. Conclusion With outpatient surgical centers becoming an increasingly popular option for lower risk procedures, emergency physicians would benefit from understanding this presentation and its pathophysiology.
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Affiliation(s)
- Daniel Yiu
- The University of Texas Health Science Center at Houston, McGovern Medical School Emergency Medicine, Houston, Texas
| | - Christopher Stephens
- The University of Texas Health Science Center at Houston, Department of Anesthesiology, Houston, Texas
| | - Jacquelyn McCullough
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
| | - Lesley Osborn
- The University of Texas Health Science Center at Houston, Department of Emergency Medicine, Houston, Texas
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Mendonça MC, Abreu JB, Gama K. Diffuse Alveolar Hemorrhage After Orotracheal Extubation Probably Induced by Sevoflurane Inhalation. Arch Bronconeumol 2021; 57:547-548. [PMID: 35699036 DOI: 10.1016/j.arbr.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/29/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Mauro Carvalho Mendonça
- Anesthesiology Department, Central Hospital of Funchal, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal.
| | - João Bettencourt Abreu
- Anesthesiology Department, Central Hospital of Funchal, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal
| | - Karina Gama
- Anesthesiology Department, Central Hospital of Funchal, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal
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Kuramoto K, Matsuyama M, Nonaka M, Takeishi T, Oshima H, Matsumura S, Nakajima M, Sakai C, Shiozawa T, Kiwamoto T, Tsukahara Y, Takayashiki N, Ogawa R, Morishima Y, Noguchi M, Hizawa N. Negative-pressure pulmonary Hemorrhaging Due to Severe Obstructive Sleep Apnea. Intern Med 2021; 60:2291-2296. [PMID: 33612674 PMCID: PMC8355386 DOI: 10.2169/internalmedicine.6206-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 24-year-old man with a history of bloody sputum for 6 months was referred to our hospital with suspected alveolar hemorrhaging due to vasculitis. Chest computed tomography showed ground-glass opacities in both lungs, and an examination of his bronchoalveolar lavage fluid showed alveolar hemorrhaging. However, no evidence of vasculitis was found, and subsequent polysomnographic testing confirmed that he had severe obstructive sleep apnea (OSA). Since the alveolar hemorrhaging improved after the initiation of continuous positive airway pressure treatment, the diagnosis was negative-pressure alveolar hemorrhaging due to severe OSA.
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Affiliation(s)
- Kenya Kuramoto
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Masashi Matsuyama
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Mizu Nonaka
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Takahiro Takeishi
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Hisayuki Oshima
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Sosuke Matsumura
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Masayuki Nakajima
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Chio Sakai
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Toshihiro Shiozawa
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Takumi Kiwamoto
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | | | - Norio Takayashiki
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Ryoko Ogawa
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Yuko Morishima
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Masayuki Noguchi
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Nobuyuki Hizawa
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Japan
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Toquet S, Cousson J, Choiselle N, Gozalo C, Giusti D, Bani-Sadr F, N'Guyen Y. Alveolar hemorrhage due to marijuana smoking using water pipe made with plastic bottle: case report and narrative review of the literature. Inhal Toxicol 2021; 33:168-176. [PMID: 34180335 DOI: 10.1080/08958378.2021.1939465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We described a case of alveolar hemorrhage (AH) after marijuana smoking using a water pipe made with plastic bottle (bong) before making a narrative review of the literature. CASE REPORT A 19-year-old male was admitted for hemoptysis and dyspnea evolving since the previous day. He smoked marijuana ten times a day using bongs. Computed tomography scan of the chest (chest CT-scan) evidenced ground glass opacities involving upper lobes with crazy-paving pattern. Bronchoalveolar lavage (BAL) yielded fluid becoming progressively bloody suggestive of AH. Screening of drug metabolites ruled out the presence of cocaine degradation products. Treatment with prednisone was prescribed and oxygen requirements decreased rapidly. The patient accepted to stop bongs, but kept on smoking marijuana using joints. He was asymptomatic 2 months later; all ground glass opacities had vanished. REVIEW OF THE LITERATURE Four cases described exactly the same circumstances as ours. All were young male patients containing ground glass opacities with diffuse or bilateral pattern in their chest CT-scan. The explanation suggested by the authors of these cases was the potential concomitant inhalation of acid anhydrides derived from use of heated plastic bottle. No acid anhydrides were experimentally evidenced after thermodesorption of heated polyethylene terephthalate (PET) (in which a majority of plastic bottles are made) we performed, but other compounds were. E-cigarette, or vaping, product use-associated lung injuries cases share some chest CT-scan patterns with those of AH following bong use and we tried to draw a parallel between these two latter before discussing a physiopathological hypothesis.
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Affiliation(s)
- Ségolène Toquet
- Service de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hôpital Robert Debré, CHU Reims, Reims, France
| | - Joël Cousson
- Unité de Réanimation Polyvalente, Hôpital Robert Debré, CHU Reims, Reims, France
| | - Nathalie Choiselle
- Ecole Nationale Supérieure d'Ingénieurs de Reims ESIREIMS, Université de Reims Champagne Ardennes, Reims, France
| | - Claire Gozalo
- Laboratoire de Pharmacologie, Hôpital Maison Blanche, CHU Reims, Reims, France
| | - Delphine Giusti
- Laboratoire d'Immunologie, Hôpital Robert Debré, CHU Reims, Reims, France
| | - Firouze Bani-Sadr
- Service de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hôpital Robert Debré, CHU Reims, Reims, France
| | - Yohan N'Guyen
- Service de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hôpital Robert Debré, CHU Reims, Reims, France
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Jo Y, Hwang J, Lee J, Kang H, Hong B. Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report. J Med Case Rep 2021; 15:137. [PMID: 33722271 PMCID: PMC7962387 DOI: 10.1186/s13256-021-02697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background 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. Case presentation 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. Conclusions Short duration of airway obstruction may cause DAH, it should be considered in the differential diagnosis of postoperative hemoptysis of unknown etiology.
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Affiliation(s)
- Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Jagyung Hwang
- Department of Anesthesiology and Pain Medicine, Daejeon Woori Hospital, Daejeon, South Korea
| | - Jieun Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Hansol Kang
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
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Park HJ, Park SH, Woo UT, Cho SY, Jeon WJ, Shin WJ. Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report. World J Clin Cases 2021; 9:1408-1415. [PMID: 33644209 PMCID: PMC7896690 DOI: 10.12998/wjcc.v9.i6.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/28/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations. Negative pressure in the lungs is created, resulting in negative pressure pulmonary edema (NPPE).
CASE SUMMARY A 78-year-old male patient diagnosed with spinal stenosis was admitted to receive a unilateral laminectomy with bilateral decompression. The patient had been diagnosed with hypertension four years earlier and asthma more than 70 years earlier. We experienced a unilateral alveolar hemorrhage associated with NPPE that occurred in a longstanding asthma patient who bit the intubated endotracheal tube for a short period during posture change at the end of surgery. Because diffuse alveolar hemorrhage accompanied by NPPE was caused in this case by airway obstruction in an older patient with asthma without known risk factors, anesthesiologists should be careful not to induce airway irritation during anesthesia awakening in asthma patients.
CONCLUSION Because diffuse alveolar hemorrhage accompanied by NPPE can occur, anesthesiologists should take care not to induce airway irritation.
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Affiliation(s)
- Hyung Joon Park
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Seung Ho Park
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Un Tak Woo
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Sang Yun Cho
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Woo Jae Jeon
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Woo Jong Shin
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
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Mendonça MC, Abreu JB, Gama K. Diffuse Alveolar Hemorrhage After Orotracheal Extubation Probably Induced by Sevoflurane Inhalation. Arch Bronconeumol 2021; 57:S0300-2896(21)00014-4. [PMID: 33612333 DOI: 10.1016/j.arbres.2020.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Mauro Carvalho Mendonça
- Anesthesiology Department, Central Hospital of Funchal, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal.
| | - João Bettencourt Abreu
- Anesthesiology Department, Central Hospital of Funchal, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal
| | - Karina Gama
- Anesthesiology Department, Central Hospital of Funchal, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal
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Bucchino L, Monzani A, Fracon S, Genoni G, Cena T, Bellone S. Cannabis-Related Diffuse Alveolar Hemorrhage in a 16-Year-Old Patient: A Case Report. Front Pediatr 2019; 7:468. [PMID: 31799223 PMCID: PMC6867963 DOI: 10.3389/fped.2019.00468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/28/2019] [Indexed: 12/28/2022] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a clinical condition characterized by the rapid onset of dyspnea, hemoptysis and acute respiratory failure (ARF). It is commonly caused by autoimmune systemic vasculitis, pulmonary infections, drugs and tumors. Here, we report a case of DAH caused by frequent cannabis smoking. A 16-year old boy presented with hemoptysis, dyspnea and ARF soon after laparoscopic surgery for varicocele in general anesthesia. The suspected diagnosis of DAH emerged from the initial chest radiography, and it was then confirmed by CT scan findings and the bronchoalveolar lavage. His general conditions completely recovered after only 24 h of oxygen supplementation and after intravenous corticosteroid and antibiotic therapy. This is the first pediatric case of DAH related to smoking marijuana, even though the inhalational anesthetic agent sevoflurane might have also been involved in this pathogenesis. Other possible causes of DAH have been considered. Negative-pressure pulmonary edema could be ruled out because no clinical evidence of upper airway obstruction was observed during general anesthesia and throughout the surgery. In addition, a possible causative role of cannabis additives/contaminants could not be excluded. Given the high prevalence of cannabis smoking in young people and that DAH can be a complication in cannabis smokers, a careful history and high index of suspicion are recommended as part of the pre-operative assessment before these patients are proceeded to receive general anesthesia.
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Affiliation(s)
- Laura Bucchino
- Pediatric Unit, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Alice Monzani
- Pediatric Unit, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Sara Fracon
- Anesthesiology and Intensive Care Unit, Accident and Emergency Department, University of Eastern Piedmont, Novara, Italy
| | - Giulia Genoni
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
| | - Tiziana Cena
- Anesthesiology and Intensive Care Unit, Accident and Emergency Department, University of Eastern Piedmont, Novara, Italy
| | - Simonetta Bellone
- Pediatric Unit, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
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