Fulminant Unilateral Pulmonary Edema on the Wrong Side

A 55-year-old patient had undergone replacement of the proximal descending aorta at the age of 17 for aortic coarctation. The patient required surgical intervention at the age of 55 for development of a false aneurysm at the distal anastomosis. Surgery was complicated by bleeding from the ruptured false aneurysm into the left upper lung lobe, which had to be resected. Recovery from surgery was uneventful. The patient could be extubated and his cardiopulmonary function was stable. On the 3rd postoperative day, acute decompensation occurred and the patient had to be reintubated for severe hypoxia. Chest X-ray showed massive opacification of the right lung indicating fulminant pulmonary edema. Interestingly, no marked changes of the remaining left lung were observed. The patient was treated with antibiotics intravenously for suspected pneumonia. In addition, diuretics and catecholamines were administered for markedly elevated cardiac preload and acute loss of peripheral vascular resistance. Within only 12 hours, the patient recovered dramatically. Follow-up chest X-ray showed no remaining opacification of the right lung. The patient was extubated and cardiopulmonary function has remained stable. The subsequent postoperative course was uneventful and the patient could be discharged from hospital 4 days later.