Purpose: To present the first photographed bronchoscopic findings asso
ciated with negative pressure pulmonary oedema (NPPE). Clinical featur
es: A previously healthy patient underwent anterior C-3-C-4 disc remov
al and arthrodesis. Following tracheal extubation he developed acute r
espiratory distress manifested as strider, tachypnoea, restlessness, a
nd desaturation. Once the trachea was reintubated, he displayed the cl
assic findings of pulmonary oedema. Bronchoscopy was performed to conf
irm tracheal tube position and to rule out tracheal injury secondary t
o surgical manipulation. Diffuse punctate haemorrhages were noted thro
ughout the visualised tracheo-bronchial tree. Conclusion: We believe t
hat these haemorrhages represent disruption of the branchial vasculatu
re and may contribute to the clinical presentation of NPPE.