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DOI: 10.1055/s-0045-1810604
Sympathetic Crashing Acute Pulmonary Edema in a Postoperative Case of Pituitary Macroadenoma
Abstract
We present a case of 58-year-old male operated for pituitary macroadenoma. On the 7th postoperative day, the patient developed sudden-onset breathlessness and desaturation needing ventilatory support. His cardiac function, which was normal preoperatively, deteriorated (ejection fraction 20%) but cardiac enzyme levels were normal. Chest X-ray was suggestive of pulmonary edema. His condition stabilized with the use of noninvasive mechanical ventilation, high-dose nitroglycerine (NTG) infusion, and furosemide over the next 12 hours. Cardiac functions improved to baseline after about a week.
Sympathetic crashing acute pulmonary edema is life-threatening entity and needs urgent intervention. It should be differentiated from cardiogenic or neurogenic pulmonary edema because treatment involves rapid lowering of blood pressure with the use of high-dose systemic vasodilators like NTG. On initial assessment, clinical condition may be confused with acute decompensated heart failure due to myocardial infarction.
Publication History
Article published online:
22 August 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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