A young woman was admitted to ICU after an attempted hanging. The neck abrasion
present on admission is shown in the above photograph. There was no evidence
of cerebral ischaemic or hypoxic damage, cervical spine injury, or carotid
artery lesions. The following picture shows her initial chest x-ray, taken shortly
after admission.
.. and a chest x-ray taken several hours later..
The question is, what caused the bilateral pulmonary infiltrates that blossomed in her lungs?
Answers?
There are several possibilities, but by far the most likely is negative pressure pulmonary oedema . This is a complex phenomenon, related to airway obstruction (or, some allege, to relief of airway obstruction). The likely mechanism is thought to be a compound of massively negative intrathoracic pressure, increased left ventricular afterload, and massive sympathetic outflow, all resulting in pooling of blood in the pulmonary capillaries causing pulmonary oedema.
The woman made a good recovery after 48 hours of ventilation with a positive end-expiratory pressure of 10 cmH 2 and avoidance of diuretic therapy.