Negative Pressure Pulmonary Edema Occurring Immediately after Tracheal Extubation

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A 65-year-old man underwent a partial hepatectomy for metastatic liver cancer, with no marked changes in hemodynamic or respiratory status. However, severe respiratory insufficiency developed immediately after extubation. Chest radiography showed a butterfly shadow and frothy sputum was suctioned from the tracheal tube on reintubation, and acute pulmonary edema was diagnosed. When acute pulmonary edema occurs immediately after extubation, chest radiography and echocardiography must be performed first to distinguish between cardiogenic and non-cardiogenic pulmonary edema, because of the different potential underlying causes and treatments. In this patient, a cardiogenic cause was ruled out, and we concluded that upper airway obstruction and excessive negative intrathoracic pressure led to pulmonary edema.