Presentation
Post anesthesia for dental extraction. Laryngospasm and hypoxia developed immediately after extubation.
Patient Data
Ill-defined ground glass opacity and confluent parenchymal shadowing in a bat’s-wing pattern with apical and peripheral sparing. Cardiomediastinal contour obscured.
There is significant radiological improvement within a period of 48 hours with mild residual ground glass opacity. The cardiomediastinum is now sharper in contour and appears normal.
Case Discussion
In the absence of any known history, the initial chest X-ray has a wide differential diagnosis including cardiogenic and non-cardiogenic pulmonary edema, ARDS, and infections including PJP and Covid 19 pneumonia. Non-cardiogenic pulmonary edema has a further large differential diagnosis. Based on the appropriate clinical scenario and a given history, one may be able to narrow the differential diagnosis.
In this instance, there is documented laryngospasm on the referral form post-extubation and therefore postobstructive pulmonary edema (a subtype of non-cardiogenic pulmonary edema) is considered the likely diagnosis. Postobstructive pulmonary edema is also called negative pressure pulmonary edema. This usually occurs upon the relief of an upper airway obstruction. It may be caused by an impacted aspirated foreign body, laryngospasm (as in this instance), epiglottitis and strangulation1.
The patient confirmed strict observance of the usual elective anesthetic requirement of fasting prior to administration of a general anesthetic, no significant past medical or surgical history, absence of any chronic illness or medication and additionally the patient was HIV negative. This ruled out many possibilities of the usual broad differential diagnosis based on the chest X-ray appearance.
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