Radiographically Severe but Clinically Mild Reexpansion Pulmonary Edema following Decompression of a Spontaneous Pneumothorax

Abstract

The case is a 48-year-old female who presented with mild dyspnea on exertion and cough with unremarkable vital signs and was found to have a large right sided pneumothorax. She underwent small bore chest tube decompression with immediate reexpansion of the collapsed lung. However, she rapidly developed moderate hypoxemia and radiographic evidence of reexpansion pulmonary edema (REPE) on both the treated and contralateral sides. Within a week, she had a normal chest X-ray and was asymptomatic. This case describes a rare complication of spontaneous pneumothorax and highlights the lack of correlation between symptoms, sequelae, and radiographic severity of pneumothorax and reexpansion pulmonary edema. Proposed pathophysiologic mechanisms include increased production of reactive oxygen species with subsequent loss of surfactant and increased vascular permeability, and loss of vasoregulatory tone.

Reexpansion pulmonary edema after treatment of secondary spontaneous pneumothorax

“…There seems to be association of increased permeability of the pulmonary vasculature to the development of reexpansion pulmonary edema. [3] Another similar case was reported by Harner and Crawley [11] in 2014, where they reported a case of a 48-year-old female patient who had a radiographically severe but clinically mild reexpansion edema following decompression of a spontaneous pneumothorax.…”

Hypoxemia after pneumothorax exsufflation: a case report

“…Two hours later, the patient became hypoxic, although pulmonary auscultation stayed symmetric and the drainage system was functional, inspiratory crackles could be heard, that's why a chest scan was obtained to exclude pulmonary oedema or residual pneumothorax not visible at the chest x ray. RPE is a syndrome characterized by the development of a pulmonary oedema most often after a rapid extraction air or liquid aspiration of a large volume (> 1.5L) from the pleural space [ 6 ]. The incidence of this syndrome varies between 0.9% and 29.8% in patients treated for spontaneous pneumothorax [ 4 ].…”