BMJ Case Reports 2018; doi:10.1136/bcr-2017-222010
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Postoperative diffuse alveolar haemorrhage: insidious negative pressure or sevoflurane induced?

  1. Clare Ross2
  1. 1 Anaesthetics, St Mary’s Hospital, Paddington, London, UK
  2. 2 Respiratory Medicine, St Mary’s Hospital, Paddington, London, UK
  1. Correspondence to Dr Rebecca Mersh, rmersh{at}
  • Accepted 14 June 2018
  • Published 10 July 2018


Negative pressure pulmonary oedema is well described in the literature as an uncommon but recognised complication of general anaesthe sia; negative pressure diffuse alveolar haemorrhage is a rarer consequence. We report a case of massive haemoptysis following elective general anaesthesia using a laryngeal mask airway device and sevoflurane anaesthetic maintenance. The patient had no obvious signs of laryngospasm or other cause of upper airway obstruction perioperatively. We explore the possibility that the haemoptysis was caused by clinically unapparent negative pressure generation, but also ask whether the anaesthetic agent should be considered as a culprit.


  • Contributors Case report discussed collaboratively, initial write-up by RM, edited and amended by CR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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