Negative Pressure Pulmonary Oedema With Pulmonary Haemorrhage Following Brief Neck Compression in an Adolescent

Negative pressure pulmonary oedema (NPPE) is well recognised in peri-operative settings but is infrequently reported following brief non-operative airway obstruction, particularly in adolescents. We report the case of an adolescent male who developed NPPE with features of concurrent negative pressure pulmonary haemorrhage (NPPH) following approximately 90 s of neck compression. He experienced transient loss of consciousness with hypoxic myoclonic activity, followed by haemoptysis and hypoxia requiring supplemental oxygen. Chest X-ray (CXR) revealed bilateral opacities, which was followed up by computed tomography (CT) of the chest demonstrating diffuse bilateral ground-glass and confluent opacities consistent with pulmonary oedema and probable superimposed haemorrhage. He recovered with supplemental oxygen alone within 48 h. This case shows that even brief neck compression can cause significant pulmonary injury, that chokeholds are an under-recognised precipitant, and that concurrent NPPH may mimic aspiration or infection, risking unnecessary intervention.