# Pulmonary ultrasound-guided management of delayed pulmonary edema secondary to nitric acid fumes inhalation: a case report

## TL;DR

A case report shows how pulmonary ultrasound helped manage delayed lung edema caused by inhaling nitric acid fumes.

## Contribution

Demonstrates the clinical utility of bedside pulmonary ultrasound in guiding treatment for delayed pulmonary edema from nitric acid inhalation.

## Key findings

- Pulmonary ultrasound dynamically monitored B-lines to assess edema severity.
- Adjusting treatment based on ultrasound findings improved patient outcomes.
- Delayed pulmonary edema is a critical concern after nitric acid fume exposure.

## Abstract

Concentrated nitric acid can form nitrogen oxides through a spontaneous redox reaction. After inhalation, it has a stimulating effect on the respiratory tract and can cause inhalation lung injury. This lung injury is mainly manifested as non-cardiogenic pulmonary edema in imaging, and pulmonary ultrasound can dynamically monitor the severity of pulmonary edema at the patient’s bedside.

This article describes a 52-year-old female case who experienced chest tightness and dyspnea 8 h after inhaling nitric acid fumes and was sent to the emergency room. Chest CT suggested diffuse exudation in both lungs, and dynamic B-lines could be seen by bedside pulmonary ultrasound. During the treatment of this patient, we adjusted the dosage of hormones and the oxygen therapy plan in a timely manner according to the evolution of B-lines under ultrasound. After treatment, her clinical symptoms gradually improved, and the re-examination of chest CT showed that the exudation in both lungs was gradually absorbed.

This case reminds clinicians to be alert to the occurrence of delayed pulmonary edema when treating patients who inhale nitric acid fumes. At the same time, dynamic examination of bedside pulmonary ultrasound is of great value in the treatment of such patients.

The online version contains supplementary material available at 10.1186/s12890-025-03758-y.