Pulmonary edema after resection of a fourth ventricle tumor: Possible evidence for a medulla-mediated mechanism

A well-recognized fact is that some patients may have development of pulmon ary edema in association with disorders of the central nervous system. The origin of this phenomenon, known as neurogenic pulmonary edema, is unclear but mag result, in part, from select pulmonary venoconstriction modulated b y autonomic outflow from the medulla oblongata, We describe a 21-year-old m an who had development of pulmonary edema in association with surgical rese ction of a brain tumor that was close to the medulla, Other than the possib ility of medullary dysfunction, which could have occurred after surgical ma nipulation, no other risk factor for pulmonary edema was identified. Of not e, the patient's blood pressure remained normal throughout the perioperativ e period, and no fluid overload or primary cardiac dysfunction was evident, This case supports the theory that the medulla is an important anatomic si te of origin for neurogenic pulmonary edema and that alterations in medulla ry function can induce pulmonary edema in humans, independent of systemic h ypertension.