1 INTRODUCTION
Diffuse alveolar hemorrhage (DAH) is characterized by damage to the alveolar microvessels and accumulation of red blood cells in the alveoli. DAH is a syndrome in which respiratory failure occurs due to hemoptysis, anemia, and hypoxemia. 1,2 Pulmonary imaging may be important in the diagnosis. The most frequent causes of DAH are forms of systemic vasculitis such as anti-glomerular basement antibodies (GBM Ab), granulomatosis with polyangitis, microscopic polyangitis, capillaritis, vasculitis, or complications that can occur in patients with diseases such as Wegener‘s granulomatosis, Goodpasture‘s syndrome, and systemic lupus erythemasus.3
DAH may also be associated with surgery and anesthesia. It has been reported that, especially in young, healthy, and muscular men with upper respiratory tract obstruction during anesthesia, negative pressure in the lungs is created, resulting in negative pressure pulmonary edema (NPPE) and, in rare cases, bilateral pulmonary hemorrhage.3 It has also been reported that one-sided alveolar or pulmonary hemorrhage may occur in cases of the development of negative intrathoracic pressure owing to upper respiratory tract obstruction or administration of a large amount of fluid to a patient in the lateral position, or in the presence of a disease such as right atrial failure.3,4 DAH, although often spontaneously resolving, can sometimes lead to fatal complications.
In the case we report here, we attempted to remove the patient’s endotracheal tube under deep anesthesia at the end of surgery in order not to irritate the airway in a patient who had lived with asthma for many years. However, we report this case with a literature review and informed consent to publication was obtained from the guardian because we experienced a unilateral DAH associated with NPPE that occurred after a short period of airway obstruction after the patient bit the intubated endotracheal tube during posture change.