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Negative-pressure pulmonary edema presented with concomitant spontaneous pneumomediastinum: Moore meets Macklin.
MedLine Citation:
PMID:  21239449     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Negative-pressure pulmonary edema is an unusual complication mainly associated with general anesthesia. It is caused by excessive negative intrathoracic pressure following a deep inspiration against an acute airway obstruction. The resultant decreased intrathoracic pressure amplifies venous return to the right heart and increases pulmonary capillary wedge pressure that can be further amplified by massive sympathetic discharge due to hypoxia. The combination of increased venous return and pulmonary capillary wedge pressure favours the shift of fluid into the pulmonary interstitium with resultant pulmonary edema. Conversely, spontaneous pneumomediastinum (SP) results from alveolar rupture following an excessive positive intrathoracic pressure. The air leaks out of the alveoli and along the perivascular space toward the mediastinum. We experienced a case of negative pulmonary edema which presented in association with SP. Pneumomediastinum is probably caused by an excessive positive intrathoracic pressure for a subsequent expiration against a closed airway. In the present case, both complications resolved with conservative management. Keywords: Negative-pressure pulmonary edema; Pneumomediastinum; General anesthesia.
Authors:
Alfonso Fiorelli; Sergio Brongo; Francesco D'Andrea; Mario Santini
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-14
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  -     ISSN:  1569-9285     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Thoracic Surgery Unit, Second University of Naples, Naples, Italy.
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