Reexpansion Pulmonary Edema after Treatment of Pneumothorax

Abstract

images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 354;19 www.nejm.org may 11, 2006 2046A 50-year-old smoker presented with acute-onset breathlessness and right-sided chest pain of four days' duration. There was no history of chest trauma. A posteroanterior chest radiograph (Panel A) demonstrated a rightsided pneumothorax. His symptoms improved immediately on placement of a chest tube. Two hours later, he again became breathless, and examination revealed extensive right-sided chest crackles. Chest radiography was repeated and showed a fully expanded right lung (Panel B), albeit with features of pulmonary edema. The arrowheads in Panel B show the position of the chest tube. The patient's condition improved after continuous positive airway pressure was delivered through a face mask overnight. The chest tube was removed after three days. At follow-up six weeks later, the patient was asymptomatic and well. The results of further investigations were consistent with the presence of mild chronic obstructive pulmonary disease.

Thoracentesis outcomes: a 12-year experience

“…Reported incidence ranges from 0.2% to 14%12 13 and carries a disproportionately high mortality rate that approaches 20% 8. Our overall REPE rate was extremely low, occurring in only 10 cases (0.01%) overall, with no deaths 14 15. We did discover a significantly higher risk of REPE when a higher volume was removed.…”

Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010

“…Continuous positive airways pressure (CPAP) has been used in a number of cases with success 37 38. If using CPAP, caution should be taken to avoid recurrent pneumothorax and potential tension pneumothorax if the RPO has occurred following the aspiration of a pneumothorax and there is no pleural drain in place.…”

Reexpansion Pulmonary Edema: analysis of eight

“…5,6 Bizim ça-lışmamızda her ne kadar geniş bir seri sunulmamış olsa da tüp torakostomi uygulanan 67 olgunun 7'sinde (%10,45), dekortikasyon yapılan 27 olgunun 1'inde (%3,70) ve toplamda olguların %8,51'inde RAÖ gelişmiş olup bu oranlar literatür ile uyumludur. [5][6][7][8] RAÖ tüp torakostomi gereken hastalarda akılda tutulması gereken önemli bir komplikasyondur. Bu durum atelektazi, plevral efüzyon ve pnömotoraksa bağlı gelişen akciğer kollapsı tedavisini takiben meydana gelir.…”

“…Günlük pratikte RAÖ vakalarında bu kadar yüksek oranda ölüm görül-memesine rağmen bu çalışmadaki veri, problemin ciddiyeti açısından uyarıcı olması bakımından önemlidir. Bizim serimizde olgu sayısı az olmakla birlikte mortalite oranı (%12,5) diğer çalışmalarla 8,29,30 uyumludur. Tüm olgularımızda kollaps 72 saatten fazla, efüzyonlu olgularımızda efüzyon miktarı 1500 ml'den çok olup, hızlı reekspanse olan pnömotoraks ve efüzyonlu olgularımızda RAÖ mortaliteye yol açmamış, ancak diğerlerinden çok daha uzun süre kollaps gelişmiş (yaklaşık 1 yıl) pakiplöritli hastanın reekspansiyonu mortal seyretmiştir.…”