Negative pressure pulmonary edema following tracheostomy tube corking unmasking suprastomal granuloma: A case report

Abstract

Background: Negative pressure pulmonary edema (NPPE) is a form of noncardiogenic pulmonary edema caused by acute upper airway obstruction. A 79-yearold male with diabetes, hypertension, COPD, and chronic kidney disease on tracheostomy developed sudden dyspnea, tachypnea, and desaturation during a corking trial for decannulation. Examination revealed bilateral crepitations, and point-of-care ultrasound showed diffuse B-lines with preserved cardiac function, suggestive of NPPE. Immediate removal of the cork and supportive management led to rapid improvement. Bronchoscopy subsequently revealed a suprastomal granulomatous lesion causing significant airway narrowing, which became clinically relevant when airflow was redirected through the upper airway during corking. This case highlights that NPPE can occur during tracheostomy corking and may unmask previously undiagnosed suprastomal airway pathology.