Reexpansion pulmonary edema: A rare complication of pneumothorax drainage

Abstract

Among all the noncardiac causes of pulmonary edema, unilateral reexpansion pulmonary edema is one of the rarest complication of expansion of a collapsed lung. It is largely unknown and a potentially fatal complication. We present the case of a 51-year-old gentleman who presented to our emergency department with shortness of breath. X-ray revealed significant right-sided pneumothorax with associated collapse of the right lung. An intercostal tube was inserted into the right 5 th intercostal space and a repeat X-ray revealed well-expanded lung field. Soon, the patient developed increased shortness of breath and hypoxia. Repeat X-ray was suggestive of pulmonary edema. He was started on noninvasive positive pressure ventilation and responded well to it. Emergency physicians should have a high index of suspicion and initiate early management of reexpansion pulmonary edema in patients suffering from pneumothoraces which have undergone drainage.

Severe re-expansion pulmonary edema after chest tube insertion for the treatment of spontaneous pneumothorax

“…Risk factors of REPE include young age (<40 years old), large pneumothorax (>30%) or large amount pleural effusion, long duration of symptoms and lung collapse (>3 days), rapid re-expansion of the lungs (<10 min), and the pleural effusion drainage of 1.5 L or more at once and negative pressure suction drainage [1,4,6,9] . The patient in this case had risk factors such as age (27 years old), total collapse, and long duration of symptoms (7 days).…”

“…Risk factors of REPE include young age (<40 years old), large pneumothorax (>30%) or large amount pleural effusion, long duration of symptoms and lung collapse (>3 days), rapid re-expansion of the lungs (<10 min), and the pleural effusion drainage of 1.5 L or more at once and negative pressure suction drainage. [ 1 , 4 , 6 , 9 ] The patient in this case had risk factors such as age (27 years old), total collapse, and long duration of symptoms (7 days). Therefore, it is important to accurately listen to the patient's medical history, including the period of onset of symptoms, and if a patient has these risk factors, efforts should be provided to expand the lungs slowly.…”

“…Chest pain, cough with foamy sputum, tachycardia, hypotension, hypoxia, cyanosis, and nausea and vomiting are also included in those of REPE. [ 2 , 4 , 9 ] Some authors recommend stopping drainage immediately if a patient starts coughing during drainage, since coughing may be the first symptom of edema development. [ 2 , 4 , 14 ] This patient had severe dyspnea, cough with foamy sputum, hypotension, hypoxia, and vomiting, thus drainage was stopped immediately.…”

“…Also, the use of diuretics should be avoided as they may worsen hypovolemia. [ 4 , 6 , 9 ] The lateral decubitus position allows a patient to bring the affected area upwards, and so to reduce shunting and increase oxygenation. Unilateral ventilation is rarely required.…”

“…Since intrapulmonary shunting can cause hypoxia or hypovolemia, fluid supply or use of inotropes is required. Also, the use of diuretics should be avoided as they may worsen hypovolemia [4,6,9] . The lateral decubitus position allows a patient to bring the affected area upwards, and so to reduce shunting and increase oxygenation.…”