Pulmonary hemorrhage in an outpatient ophthalmic anesthesia setting - it's never "just a cataract"

A 48-year-old man, with end stage renal disease and a history of recreational drug abuse, presented for elective cataract surgery. Patient underwent the procedure with a general endotracheal anesthesia with a balanced anesthetic. After an uneventful intra-operative period, he had a sudden onset large volume hemoptysis just prior to extubation. Poor oxygenation and hemodynamic instability necessitated emergent reintubation in the immediate post-extubation period. Emergent bronchoscopy did not show active airway bleeding or obstructive mucous plugs, and a diagnosis of diffuse alveolar hemorrhage was made. The patient was gradually weaned off the ventilator and made a slow recovery over a one - week period.