Postextubation negative-pressure pulmonary edema after an appendectomy

Negative pressure pulmonary edema (NPPE) is a rare, underdiagnosed, and potentially dangerous postoperative complication with the prevalence of 0.05%-0.1%. An 18-year-old healthy and athletic male developed a sensation of a lump in the throat, hemoptysis, wheezing, and acute respiratory failure, after an extubation following general anesthesia for an uncomplicated appendectomy. Computed tomography showed extensive bilateral pulmonary edema. He was managed with supplemental oxygen, albuterol, and diuretic. Supplemental oxygen was weaned off on hospital day 3. The hospital course was complicated by presyncope from orthostatic hypotension secondary to over-diuresis. The pathophysiology, diagnosis, management, and outcome of NPPE are illustrated and discussed in this case report. Furthermore, this case highlights that clinicians should balance the benefit of removing fluid from lungs and the risk of hypovolemia with the cautious use of diuretic.