Negative pressure pulmonary edema in the immediate postoperative period of mastopexy with scar revision

a case report

Abstract

Introduction: Negative pressure pulmonary edema (NPPE) is a rare and potentially severe respiratory complication, usually associated with acute upper airway obstructions such as laryngospasm. It is characterized by sudden hypoxemia resulting from extreme negative intrathoracic pressures, leading to fluid extravasation into the alveoli. Case report: A 28-year-old previously healthy female patient underwent mastopexy with scar revision under total intravenous general anesthesia associated with erector spinae plane block. In the immediate postoperative period, she presented with sudden desaturation and clinical signs consistent with NPPE. Lung ultrasound (US) revealed multiple coalescent B-lines, with favorable response after noninvasive ventilatory support. Discussion: This case reinforces the pathophysiology of NPPE described in the literature, associating vigorous inspiratory efforts against a partially obstructed airway with the development of edema. The importance of early diagnosis, point-of-care lung ultrasound, and noninvasive ventilation in the rapid reversal of the condition is highlighted. Conclusion: NPPE can occur even in young patients without comorbidities, following low-risk surgeries. Vigilance during the post-extubation period and early recognition of clinical signs are essential to avoid adverse outcomes. This report emphasizes the need for preventive strategies and training of the multidisciplinary team for the proper management of such complications.