Edema pulmonar por presión negativa. Reporte de caso / Pulmonary edema by negative pressure. Case report

El edema pulmonar por presión negativa representa el 0.1% de las complicaciones pulmonares de los pacientes post ­ quirúrgicos, y la condicionante del incremento de dicha incidencia es la existencia de algún tipo de obstrucción de la vía aérea llegando hasta un 11% de casos. Su incidencia y prevalencia no son claras ya que es una entidad con infradiagnóstico. En los reportes de casos se coincide que la mayoría de pacientes son jóvenes con evaluaciones de riesgo quirúrgico bajos previamente sanos y que desarrollan en forma súbita un cuadro de edema agudo de pulmón, casi siempre posterior a la anesthesia, encontrándose ya no orointubados. La intensa presión negativa intrapleural secundaria al esfuerzo inspiratorio genera en el intersticio pulmonar pericapilar el gradiente transmural suficiente para producir edema. La hipoxemia, hipercapnia, acidosis e hipersecreción adrenérgica se suman al escenario, determinando las características fisiopatológicas, clínicas, radiológicas y evolutivas de esta entidad.3-4. El edema pulmonar resultante puede aparecer en pocos minutos tras la obstrucción de la vía aérea o de forma diferida al cabo de varias horas. Este cuadro clínico es potencialmente grave, pero habitualmente responde bien al tratamiento con oxigenoterapia, en raros casos es necesaria la ventilación mecánica a presión positiva y diuréticos...(AU)

Pulmonary edema by negative pressure represents 0.1% of pulmonary complications in post - surgical patients, and the condition of the increase in this incidence is the existence of some type of airway obstruction reaching up to 11% of cases. Its incidence and prevalence are not clear since it is an entity with underdiagnosis. In the case reports it is agreed that the majority of patients are young with previously low risk surgical evaluations who develop suddenly a picture of acute pulmonary edema, almost always after anesthesia, and are no longer orointubed. The intense negative intrapleural pressure secondary to the inspiratory effort generates in the pericapillary pulmonary interstice the transmural gradient sufficient to produce edema. Hypoxaemia, hypercapnia, acidosis and adrenergic hypersecretion are added to the scenario, determining the physiopathological, clinical, radiological and evolutionary characteristics of this entity.3-4. The resulting pulmonary edema may appear within a few minutes after the obstruction of the airway or deferred after several hours. This clinical picture is potentially serious, but usually responds well to treatment with oxygen therapy, in rare cases it is necessary mechanical ventilation at positive pressure and diuretics ... (AU)  

Edema e enfisema pulmonar agudo em bovinos no Sul do Brasil: doença espontânea e reprodução experimental / Acute pulmonary edema and emphysema in cattle in Southern Brazil: spontaneous disease and experimental reproduction

The paper reports the epidemiological data, clinical signs and lesions of four outbreaks of acute pulmonary edema and emphysema in cattle (ABPE) which occurred in the states of Parana and Santa Catarina, as well as its experimental reproduction. The spontaneous disease occurred after the cattle was transferred from a mature and dry pasture to another luxurious sprouting one. All affected animals were adult dairy cows of Holstein and Brown Swiss breed. The main clinical signs were dyspnea of laborious abdominal breathing with extended neck and open mouth.The sick animals also presented subcutaneous emphysema, decreased milk production, slow recovery or death. Postmortem findings were restricted to a dark red not collapsed lung, which was shiny and hyper sizzling more than usual and with marked interlobular emphysema. Histological lesions in the lung consisted of alveolar and interlobular emphysema, areas with congestion and edema, hyaline degeneration of the alveolus wall and moderate diffuse infiltration of macrophages and eosinophils. The experimental reproduction of the disease was performed in a cow by orally administration of 0.7mg/kg /LW of L-Tryptophan single dose. The animal died on the seventh day of the experiment. The clinical signs and lesions were similar to those observed in the naturally occurring disease.

Descrevem-se os dados epidemiológicos, os sinais clínicos e as lesões de quatro surtos da doença do edema e enfisema pulmonar agudo em bovinos (EEPAB) nos estados de Santa Catarina e Paraná e sua reprodução experimental. A doença espontânea ocorreu após transferência de bovinos de pastagem madura e seca para outra jovem e viçosa. Todos os bovinos afetados eram vacas das raças holandês e pardo suíço. Os principais sinais clínicos foram dispneia e respiração abdominal dificultosa com o pescoço estendido e a boca aberta. Apresentaram, também, enfisema subcutâneo, queda na produção de leite e recuperação lenta ou morte. Os achados de necropsia foram restritos ao pulmão o qual tinha coloração vermelho escuro, não colabado, de aspecto brilhante e hipercriptante com enfisema interlobular acentuado. As lesões histológicas no pulmão consistiam principalmente de enfisema alveolar e interlobular intercalado por áreas de congestão e edema, degeneração hialina da parede dos alvéolos e infiltrado de macrófagos e eosinófilos, moderado, difuso. A reprodução experimental da doença foi realizada em um bovino, com administração de 0,7mg/kg de peso corporal de L-triptofano por via oral em dose única. O animal morreu no sétimo dia de experimento. Os sinais clínicos e lesões foram idênticos aos observados na doença espontânea.