1 INTRODUCTION
Diffuse alveolar hemorrhage (DAH) is characterized by damage to the
alveolar microvessels and accumulation of red blood cells in the
alveoli. DAH is a syndrome in which respiratory failure occurs due to
hemoptysis, anemia, and hypoxemia. 1,2 Pulmonary
imaging may be important in the diagnosis. The most frequent causes of
DAH are forms of systemic vasculitis such as anti-glomerular basement
antibodies (GBM Ab), granulomatosis with polyangitis, microscopic
polyangitis, capillaritis, vasculitis, or complications that can occur
in patients with diseases such as Wegener‘s granulomatosis,
Goodpasture‘s syndrome, and systemic lupus erythemasus.3
DAH may also be associated with surgery and anesthesia. It has been
reported that, especially in young, healthy, and muscular men with upper
respiratory tract obstruction during anesthesia, negative pressure in
the lungs is created, resulting in negative pressure pulmonary edema
(NPPE) and, in rare cases, bilateral pulmonary hemorrhage.3 It has also been reported that one-sided alveolar or
pulmonary hemorrhage may occur in cases of the development of negative
intrathoracic pressure owing to upper respiratory tract obstruction or
administration of a large amount of fluid to a patient in the lateral
position, or in the presence of a disease such as right atrial failure.3,4 DAH, although often spontaneously resolving, can
sometimes lead to fatal complications.
In the case we report here, we attempted to remove the patient’s
endotracheal tube under deep anesthesia at the end of surgery in order
not to irritate the airway in a patient who had lived with asthma for
many years. However, we report this case with a literature review and
informed consent to publication was obtained from the guardian because
we experienced a unilateral DAH associated with NPPE that occurred after
a short period of airway obstruction after the patient bit the intubated
endotracheal tube during posture change.