title: Polytetrafluoroethylene fume-induced pulmonary edema: a case report and review of the literature.
abstract: BACKGROUND
  Polytetrafluoroethylene is ubiquitous in materials commonly used in cooking and industrial applications. Overheated polytetrafluoroethylene can generate toxic fumes, inducing acute pulmonary edema in some cases. However, neither the etiology nor the radiological features of this condition have been determined. For clarification, we report an illustrative case, together with the first comprehensive literature review.
  
  
  METHODS
  A previously healthy 35-year-old Japanese man who developed severe dyspnea presented to our hospital. He had left a polytetrafluoroethylene-coated pan on a gas-burning stove for 10 hours while unconscious. Upon admission, he was in severe respiratory distress. A chest computed tomographic scan showed massive bilateral patchy consolidations with ground-glass opacities and peripheral area sparing. A diagnosis of polytetrafluoroethylene fume-induced pulmonary edema was made. He was treated with non-invasive positive pressure ventilation and a neutrophil elastase inhibitor, which dramatically alleviated his symptoms and improved his oxygenation. He was discharged without sequelae on hospital day 11. A literature review was performed to survey all reported cases of polytetrafluoroethylene fume-induced pulmonary edema. We searched the PubMed, Embase, Web of Science and OvidSP databases for reports posted between the inception of the databases and 30 September 2014, as well as several Japanese databases (Ichushi Web, J-STAGE, Medical Online, and CiNii). Two radiologists independently interpreted all chest computed tomographic images. Eighteen relevant cases (including the presently reported case) were found. Our search revealed that (1) systemic inflammatory response syndrome was frequently accompanied by pulmonary edema, and (2) common computed tomography findings were bilateral ground-glass opacities, patchy consolidation and peripheral area sparing. Pathophysiological and radiological features were consistent with the exudative phase of acute respiratory distress syndrome. However, the contrast between the lesion and the spared peripheral area was striking and was distinguishable from the common radiological features of acute respiratory distress syndrome.
  
  
  CONCLUSIONS
  The essential etiology of polytetrafluoroethylene fume-induced pulmonary edema seems to be increased pulmonary vascular permeability caused by an inflammatory response to the toxic fumes. The radiological findings that distinguish polytetrafluoroethylene fume-induced pulmonary edema can be bilateral ground-glass opacity or a patchy consolidation with clear sparing of the peripheral area.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan. rhamaya-circ@umin.ac.jp.
authors.forename: Rikuta
authors.initials: R
authors.lastname: Hamaya
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan. windmill@fmu.ac.jp.|Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan. windmill@fmu.ac.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan. ya51_xyz@yahoo.co.jp.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Chida
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. inokuchir-icu@h.u-tokyo.ac.jp.|Department of General and Emergency Medicine, JR General Hospital, Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan. inokuchir-icu@h.u-tokyo.ac.jp.
authors.forename: Ryota
authors.initials: R
authors.lastname: Inokuchi
authors.affiliation: Department of Radiology, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan. kikuken@fmu.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Department of Radiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan. t.tameta@gmail.com.
authors.forename: Tadanobu
authors.initials: T
authors.lastname: Tameda
authors.affiliation: Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan. c-tase@fum.ac.jp.
authors.forename: Choichiro
authors.initials: C
authors.lastname: Tase
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan. k-shinohara@ohta-hp.or.jp.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shinohara
mesh_terms: D000328:Adult; D004417:Dyspnea; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011138:Polytetrafluoroethylene / Q000009:adverse effects*; D011175:Positive-Pressure Respiration; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D011138:Polytetrafluoroethylene