Korean J Anesthesiol.  2010 Dec;59(Suppl):S163-S166. 10.4097/kjae.2010.59.S.S163.

Bilateral upper lobe pulmonary edema during gynecologic laparoscopic surgery in the Trendelenberg position: A case report

• Shim JH
• Shin WJ
• Lee SH

• KMID: 2237378
• DOI: http://doi.org/10.4097/kjae.2010.59.S.S163

Abstract

A 25-year-old woman was diagnosed with a ruptured ectopic pregnancy. During laparoscopic surgery, the patient was in the Trendelenberg position (20degrees degrees). Massive froth in the endotracheal tube was observed at the end of surgery. A portable chest x-ray, checked at the end of the operation, showed diffuse haziness in both upper lung fields. After one hour of aggressive treatment with drugs and positive mechanical ventilation, the amount of froth in the endotracheal tube was reduced considerably. Considering the symptom and radiologic findings, we concluded that diffuse bilateral upper lung field haziness was due to atypical pulmonary edema. We speculated that the rapid improvement of pulmonary edema was due to redistribution of fluid to the lowest part of lung by immediate reversing the patient's Trendelenberg position, along with aggressive treatment.

Keyword

Laparoscopic surgery; Trendelenberg position; Upper lobe pulmonary edema

MeSH Terms

Adult
Female
Humans
Laparoscopy
Lung
Pregnancy
Pregnancy, Ectopic
Pulmonary Edema
Respiration, Artificial
Thorax