Negative Pressure Pulmonary Edema Following Extubation for Appendectomy in a 17-Year-Old Patient: A Case Report Highlighting the Value of Cardiac Point-of-Care Ultrasound (POCUS) in Guiding Conservative Management.

Negative pressure pulmonary edema (NPPE) is a rare, life-threatening, yet rapidly reversible complication of acute upper airway obstruction. We present the case of a 17-year-old healthy male who underwent an emergency appendectomy under general anesthesia. Immediately following extubation, he developed severe respiratory distress and desaturation (SpO₂ 70%) due to presumed glossoptosis and reactive laryngospasm. Despite initial stabilization, he deteriorated in the Post-anesthesia Care Unit, exhibiting hypoxemia and pink frothy sputum. Arterial blood gases confirmed acute respiratory acidosis, while chest radiography revealed diffuse bilateral alveolar opacities. A completely normal point-of-care ultrasound (POCUS) served as a valuable adjunct to effectively rule out cardiogenic edema. The patient was managed conservatively with supplemental oxygen and nebulized bronchodilators, while loop diuretics were deliberately avoided. He showed rapid clinical improvement, weaning to room air within six hours, with complete radiological resolution by the next morning. While NPPE is a recognized complication, the educational novelty of this case lies in highlighting the efficacy of targeted conservative management. It underscores the adjunctive role of POCUS in safely avoiding inappropriate diuresis and emphasizes the paramount need for continuous vigilance following extubation.