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Neurogenic pulmonary oedema
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  1. Bas van Bussel1,
  2. Nicky Peters2,3,
  3. Marcel Aries1
  1. 1Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
  2. 2Department of Radiology, Zuyderland Medical Centre, Heerlen, The Netherlands
  3. 3Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
  1. Correspondence to Dr Marcel Aries, marcel.aries{at}mumc.nl

https://doi.org/10.1136/bcr-2017-224011

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    Description

    A 42-year-old healthy woman was found unresponsive with a peripheral oxygen saturation of 80% after having a thunderclap headache. She had copious pink respiratory secretions. Emergency intubation was performed. Cerebral CT showed subarachnoid haemorrhage from a right internal carotid aneurysm. Thoracic CT revealed extensive bilateral patchy consolidations with air bronchograms, mainly in dependent lung areas (figure 1: coronal plane; figure 2: transverse plane). Her PaO2/FiO2 ratio was initially 157 mm Hg and improved significantly over 24 hours. These findings were consistent with acute neurogenic pulmonary oedema (ie, interstitial and alveolar fluid) which results from changes in cardiopulmonary physiology caused by extreme sympathetic discharge after an acute neurological insult. Serial echocardiography showed initially impaired left ventricular function that fully recovered over 2 days. Extubation was successful after 30 hours. The clinical course supports the diagnosis of neurogenic pulmonary oedema. After a complicated recovery (due to vasospasms and hydrocephalus), she was discharged for rehabilitation therapy 1 month postadmission.

    Figure 1
    Figure 1

    Thoracic CT showing extensive bilateral patchy consolidations with air bronchograms, mainly in dependent lung areas, coronal plane.

    Figure 2
    Figure 2

    Thoracic CT (as figure 1), transverse plane.

    In conclusion, acute neurogenic pulmonary oedema may accompany subarachnoid haemorrhage. Although relatively rare, clinicians should be aware of this neurogenic pulmonary complication that has a good prognosis with appropriate intervention.

    Learning points

    • Neurogenic pulmonary oedema is a rare but life-threatening complication of a subarachnoid haemorrhage.

    • Rapid intervention with intubation is often warranted to organise diagnostic cerebral and cardiothoracic evaluation.

    • The underlying extreme sympathetic discharge of neurogenic pulmonary oedema is often self-resolving and has a good prognosis.

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    Footnotes

    • Contributors BvB and MA wrote the manuscript. NP selected the images. All authors read and approved the final version of the manyscript, as submitted.

    • 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.