# When extubation turns fatal: Delayed hemoptysis from negative pressure pulmonary hemorrhage

## TL;DR

A rare case of fatal delayed hemoptysis caused by negative pressure pulmonary hemorrhage after extubation is reported and discussed.

## Contribution

The paper presents a novel clinical case highlighting the under-recognized complication of NPPH post-extubation.

## Key findings

- A 25-year-old diabetic male developed sudden hemoptysis and dyspnea after varicocelectomy.
- Imaging showed bilateral pulmonary infiltrates consistent with alveolar hemorrhage.
- Supportive treatment led to full recovery, emphasizing the importance of early recognition of NPPH.

## Abstract

Negative pressure pulmonary hemorrhage (NPPH) is a rare but serious complication following upper airway obstruction, often due to forceful inspiratory efforts.

We report a case of a 25-year-old diabetic male who developed sudden hemoptysis and dyspnea after routine varicocelectomy. The patient had likely bitten the endotracheal tube during extubation, causing transient airway obstruction. Imaging showed bilateral pulmonary infiltrates consistent with alveolar hemorrhage. Other causes were excluded, and supportive treatment led to full recovery.

This case underscores the importance of recognizing NPPH early in the postoperative period to prevent misdiagnosis and ensure prompt, effective management.