Transfusion-Related Acute Lung Injury Detected by Perioperative Lung Ultrasound: Early Recognition With Point-of-Care Ultrasound (POCUS)

TL;DR

A case shows how lung ultrasound can help detect a rare but serious blood transfusion reaction called TRALI early.

Contribution

This case demonstrates the use of point-of-care ultrasound for early detection of TRALI in a postoperative setting.

Findings

POCUS identified bilateral B-lines indicative of non-cardiogenic pulmonary edema.

CT confirmed bilateral ground-glass opacities and septal thickening consistent with TRALI.

The patient improved rapidly with supplemental oxygen after TRALI was diagnosed.

Abstract

Transfusion-related acute lung injury (TRALI) is a rare but potentially life-threatening transfusion reaction characterized by acute hypoxemia and non-cardiogenic pulmonary edema within six hours of transfusion. We report the case of a 20-year-old female patient who developed acute hypoxemia approximately 1.5 hours after receiving one unit of packed red blood cells (PRBCs) during dilation and suction curettage under general anesthesia. Postoperatively, she experienced dyspnea, oxygen desaturation, and coarse bilateral breath sounds. Point-of-care ultrasound (POCUS) demonstrated multiple bilateral B-lines without evidence of pneumothorax, effusion, or cardiac dysfunction, raising suspicion for non-cardiogenic pulmonary edema. Computed tomography (CT) further revealed bilateral ground-glass opacities and septal thickening, supporting the diagnosis of TRALI. The patient required supplemental oxygen and demonstrated rapid clinical improvement. This case highlights the clinical utility of lung POCUS as an early diagnostic adjunct for differentiating TRALI from other causes of acute postoperative respiratory decompensation.

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