title: [Acute pulmonary edema in adult caused by tonsillar hypertrophy following removal of laryngeal mask airway].
abstract: Negative pressure pulmonary edema (NPPE) has been described after acute airway obstruction. In the following case, we observed a rare occurrence of pulmonary edema caused by chronic tonsillar hypertrophy in a woman following removal of laryngeal mask airway (LMA). A 38-year-old woman with breast cancer underwent mastectomy under general anesthesia using the LMA. With the patient fully awake, the LMA was removed. Abruptly 7 minutes afterward, she showed signs of intense dyspnea, generalized rhonchus and progressive desaturation, and obstructive tonsillar hypertrophy was noticed. Acute lung edema was suspected and treatment started with oxygen therapy, bronchodilators, intravenous corticoids and loop diuretics. She was then intubated to secure airway and provide adequate ventilation with PEEP. Fortunately, the symptoms progressively remitted satisfactorily, and she was subsequently extubated 18 hours later with no complications. NPPE is an infrequent medical emergency and its early diagnosis and recognition are likely to lead to successful management of this potentially serious complication.
authors.affiliation: Department of Anesthesia, National Cancer Center Hospital, Tokyo 104-0045.
authors.forename: Toru
authors.initials: T
authors.lastname: Iizuka
authors.forename: Naohito
authors.initials: N
authors.lastname: Shimoyama
authors.forename: Atsuko
authors.initials: A
authors.lastname: Notoya
mesh_terms: D000208:Acute Disease; D000328:Adult; D000768:Anesthesia, General; D001943:Breast Neoplasms / Q000601:surgery; D001993:Bronchodilator Agents / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D006931:Hyperbaric Oxygenation; D006965:Hyperplasia; D017214:Laryngeal Masks / Q000009:adverse effects*; D014066:Palatine Tonsil / Q000473:pathology*; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D006854:Hydrocortisone