Differential Diagnosis for Pulmonary Oedema after Oesophageal Anastomosis

• Single most likely diagnosis:

  • Fluid Overload due to Blood Transfusion: This is a common cause of pulmonary oedema in the post-operative period, especially after surgeries that involve significant blood loss and subsequent transfusions, like oesophageal anastomosis. The transfused blood can lead to volume overload, particularly if the patient's cardiac function is compromised or if the transfusion rate exceeds the patient's ability to compensate.

• Other Likely diagnoses:

  • Heart Failure: Patients undergoing major surgery like oesophageal anastomosis may have underlying heart disease that can be exacerbated by the stress of surgery, leading to heart failure and pulmonary oedema.
  • Anti-Diuretic Hormone (ADH) Secretion: Also known as the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), this can occur in response to the stress of surgery, leading to water retention and potentially causing pulmonary oedema.

• Do Not Miss diagnoses:

  • Tension Pneumothorax: Although less common, a tension pneumothorax can cause pulmonary oedema due to the increased pressure affecting venous return and cardiac output. It's a life-threatening condition that requires immediate intervention.
  • Anaphylactic Reaction: A severe allergic reaction to blood products or other substances used during surgery can lead to pulmonary oedema among other symptoms. It's critical to recognize and treat anaphylaxis promptly.

• Rare diagnoses:

  • Transfusion-Related Acute Lung Injury (TRALI): A rare but serious complication of blood transfusion, characterized by non-cardiogenic pulmonary oedema. It's essential to consider TRALI in the differential diagnosis of pulmonary oedema post-transfusion.
  • Pulmonary Embolism: While not directly related to the surgical procedure, pulmonary embolism can occur in the post-operative period due to immobility and should be considered in the differential diagnosis of acute respiratory distress.