A thoracic cavity drain was inserted, but the patients respiration and circulation became. Reexpansion pulmonary edema after therapeutic thoracentesis. Reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. Largevolume thoracentesis and the risk of reexpansion pulmonary edema. A case of severe hypovolemic shock with reexpansion. Reexpansion pulmonary edema is a rare but recognized complication of draining pleural effusions and pneumothoraces that has not been described previously in association with physicianled thoracoscopy.
Reexpansion pulmonary edema following thoracentesis cmaj. Risk factors for the development of reexpansion pulmonary. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased pulmonary surfactant levels and a proinflammatory status are putative mechanisms. Decreased lung interstitial pressure caused by rapid expansion of a collapsed lung has been thought to be an essential factor for the development of rpe. Reexpansion pulmonary edema, pleural effusion, steroid pulse therapy, chest drainage. Reexpansion pulmonary edema reexpansion pulmonary edema dubin, jeffrey s 20001101 00. Reexpansion pulmonary oedema rpo is a rare complication that can occur after rapid reinflation of the lung following drainage of a pleural effusion or pneumothorax. Reexpansion pulmonary edema following local anesthetic thoracoscopy. The prevalence of rpo is quite rare,1 2 generally cited as less than 1% of cases. Reexpansion pulmonary edema rpe is a lifethreatening but rare complication after reexpansion of a collapsed lung. Repeated chest xray imaging revealed increased alveolar opacification of the right lung consistent with pulmonary edema. We present here 2 cases of reexpansion pe in which edema fluids drained from endobronchial tubes during videoassisted thoracic surgery vats for. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition.
If edema should occur, however, it resolves in five or six days without permanent sequelae. On admission, a chest xray showed complete whiteout of the right hemithorax with contralateral mediastinal deviation compatible with a large pleural effusionpresumed to be hepatic. Despite being infrequent, mortality may occur in up to 20% of cases and is attributed to the abrupt reduction in pleural pressure, especially as a result of extensive. We successfully managed a case of serious hypovolemic shock with reexpansion pulmonary edema rpe. Is severe reexpansion pulmonary edema still a lethal complication. Severe reexpansion pulmonary edema induced by onelung. Reexpansion pulmonary edema following tube thoracostomy for spontaneous pneumothorax in an elderly male 4. The condition occurs in the setting of rapid expansion of a collapsed lung, with acute onset shortness of breath usually occurring within hours of reexpansion. There are many accounts of repe occurring in adults, but to my knowledge, this problem has not been reported in.
Reexpansion pulmonary edema is a rare but potentially lifethreatening condition that occurs when a collapsed lung reexpands, usually in the same side of collapsed lung. Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased. The onset of pulmonary edema can be delayed by up to 24 hours in some cases. Reexpansion pulmonary edema definition of reexpansion. This iatrogenic complication, termed reexpansion pulmonary edema rpe, may occur after the treatment of a lung that has collapsed because of a pneumothorax or pleural effusion. We investigated the risk factors for the development of repe in patients with spontaneous pneumothorax. To avoid reexpansion pulmonary edema rpe, thoracenteses are often limited to draining no more than 1 l. Reexpansion pulmonary edema parallels reperfusion reoxygenation injuries in other organs in that hypoxic and hypoperfused lung tissue develops increased vascular. Reexpansion pulmonary edema repe is known as a rare and fatal complication after tube thoracostomy.
Ipsilateral reexpansion pulmonary edema after drainage of a. Effective steroid therapy for reexpansion pulmonary edema. There is unilateral left lung reexpansion pulmonary edema. Barotrauma is well known to be a relatively common complication of highfrequency jet ventilation hfjv. The patient had been taking penicillin for 2 days without improvement. The pathogenesis of rpe is probably related to histological changes of the lung parenchyma and reperfusiondamage by free radicals leading to an. Reexpansion pulmonary oedema repe is described in the literature, mostly after drainage of more than approximately 1 l of fluid from the pleural space. This condition is a relatively unknown complication of intercostal chest drainage and is potentially lethal in 20% of cases. Reexpansion pulmonary oedema repo constitutes a non rare complication with many not yet elucidating causative factors. Reexpansion pulmonary edema rpe is a rare complication that may occur after treatment of lung collapse caused by pneumothorax, atelectasis or pleural effusion and can be fatal in 20% of cases. Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax, pleural effusion or removal of any space occupying lesion. Patients may present with radiographic findings alone or may have signs or symptoms that prompt evaluation and diagnosis. Analysis of edema fluids and histologic features of the.
Ipsilateral reexpansion pulmonary edema after drainage of. Elevated levels of interleukin8 and leukotriene b4 in pulmonary fluid of a patient with reexpansion pulmonary edema. Reexpansion pulmonary edema radiology reference article. After undergoing tube thoracostomy drainage for the pleural effusion, a contralateral reexpansion pulmonary edema. The high mortality rate, reported up to 21%, presses the issue for finding adequate prevention and treatment. A 47yearold man developed pneumothorax 11 days after a previous injury. Carlos echevarria, darragh twomey, joel dunning, binayak chanda, does reexpansion pulmonary oedema exist. A 38yearold woman was diagnosed with massive left pleural effusion caused by advanced breast cancer approximately 1 month ago. Risk factors for reexpansion pulmonary edema should be evaluated and. Reexpansion pulmonary edema pe is a rare complication of general thoracic surgery. Largevolume thoracentesis and the risk of reexpansion. Reexpansion pulmonary edema is a rare complication that may occur after drainage of pneumothorax or pleural. The role of tissue reperfusion in the reexpansion injury of the lungs.
Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical. On the left, there is a large rightsided pneumothorax white arrows. Re expansion pulmonary edema following thoracentesis. The patient received supplemental oxygen via a nonrebreather face mask to compensate for hypoxemia.
Development of unilateral pulmonary edema in the reexpanded lung is a rare but recognized complication of evacuation of a pneumothorax and rapid pulmonary reexpansion. A case of pulmonary edema following reexpansion of a collapsed lung due to pneumothorax is described and illustrated. Pulmonary edema is due to the movement of excess fluid into the alveoli as a result of an alteration in one or more of starlings forces. Pdf reexpansion pulmonary edema a case report researchgate. Pdf reexpansion pulmonary edema rpe is a rare, but frequently lethal. Reexpansion pulmonary edema is an uncommon but important cause of noncardiogenic pulmonary edema. Reexpansion pulmonary edema is a rare complication that may occur after drainage of pneumothorax or pleural effusion. Reexpansion pulmonary edema rpe is a rare entity that develops after reexpansion in a chronically collapsed lung.
Reexpansion pulmonary edema following local anesthetic. Reexpansion pulmonary edema rpe is a rare complication that may occur. This type of pulmonary edema is preventable by gradual expansion of the lung collapsed by pneumothorax. Reexpansion pulmonary edema, journal of cardiothoracic and. Although most patients completely recover within five to seven days, severe re expansion pulmonary edema can lead to sequestration of large quantities of fluid in the lung, which may result in shock and possibly death. Reexpansion pulmonary edema appears to be due to increased pulmonary capillary permeability rather than to hemodynamic mechanisms. Reexpansion pulmonary edema after chest drainage for. Pdf reexpansion pulmonary edema partha chakraborty. Unilateral reexpansion pulmonary edema rpe is a rare complication of the. Reexpansion pulmonary edema rpe is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of lung collapse. In fact, the average incidence of this syndrome should be much higher than 1% mentioned in your article. Reexpansion pulmonary edema following thoracentesis.
Reexpansion pulmonary edema rpe is a rare complication of therapeutic thoracentesis. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are implicated in. Two instances of unilateral pulmonary edema occurring as the result of rapid reexpansion of pneumothorax are described and illustrated. Acute hypoxemic respiratory failure after largevolume. The symptoms of rxpe usually appear within the first two hours following pulmonary reexpansion. An hour after chest tube insertion red arrows, there is now airspace disease in the right lung yellow arrow, which has been reexpanded. Reexpansion pulmonary edema the journal of the american. Here we report a new management modality that is very useful for a patient with rpe.
Reexpansion pulmonary edema reexpansion pulmonary edema neustein, steven m. Clinical presentations include cough, chest discomfort and hypoxemia. It results in acute onset shortness of breath that usually results within hours of reexpansion but can be delayed by 24 hours in some cases. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of. There are, however, significant clinical benefits to removing more than 1 l of fluid. The incidence referred is less than 1%, and mortality can reach up to 20%. We report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. Reexpansion pulmonary edema occurs within 24 hours of the drainage procedure and is characterized by hypoxemia and alveolar infiltrates in the reexpanded lung and even rarely in the contralateral lung. Unilateral reexpansion pulmonary edema rpe is a rare complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis. The exact pathophysiology leading to this complication is not known. Reexpansion pulmonary edema may be considered an iatrogenic complication due to rapid emptying of the pleural cavity. A number of factors have been identified that increase the risk of developing reexpansion pulmonary edema, and pathophysiologic mechanisms have been postulated. Reexpansion pulmonary edema is a noncardiogenic pulmonary edema that occurs in the setting of rapid expansion of a collapsed lung.
Reexpansion pulmonary oedema in pneumothorax bmj case. Reexpansion pulmonary edema repe is an uncommon problem that afflicts the reexpanded lung after evacuation of a large pneumothorax or pleural effusion. Pulmonary edema is a condition characterized by fluid accumulation in the lungs caused by extravasation of fluid from pulmonary vasculature into the interstitium and alveoli of the lungs. The development of such edema can be prevented by avoiding application of sudden and excessive negative pleural pressures during the evacuation of a pneumothorax or a pleural effusion. Reexpansion pulmonary edema rxpe is a rare form of acute lung injury, with an incidence of approximately 1% following evacuation of a pneumothorax. After the insertion of a chest tube he developed a reexpansion pulmonary edema, which had to be treated by an intubation. Reexpansion pulmonary edema the annals of thoracic surgery. A 12french chest tube was placed, and ml of pleural effusion was drained for approximately 1 hour. Download as ppt, pdf, txt or read online from scribd. There is a broad clinical spectrum of the disease ranging from asymptomatic. We selected patients who were diagnosed with spontaneous pneumothorax and were initially treated with tube thoracostomy between august 1, 2003 and december 31, 2011. His medical history also included alcoholic cirrhosis with portal hypertension and ascites.
Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural cavity performed by either thoracentesis or chest drainage. Therefore, early recognition of signs and symptoms is important since inadequate or delayed. Reexpansion pulmonary edema by talal alzahrani, nawaf. The importance of recognizing this relatively uncommon phenomenon is stressed. Reexpansion pulmonary edema, journal of emergency medicine. Pdf reexpansion pulmonary edema following thoracentesis. In cardiogenic pulmonary edema, a high pulmonary capillary pressure as estimated clinically from the pulmonary artery wedge pressure. A 46yearold man presented to the emergency department with moderate dyspnoea and a 4day history of cough. You will receive an email whenever this article is corrected, updated, or cited in the literature. The purpose of this study was to define the incidence of rpe among patients undergoing largevolume. Symptomatic reexpansion pulmonary edema occurs in less than 1% of patients after largevolume thoracentesis. Unfortunately, there is no definitive treatment modality for rpe.
Reexpansion pulmonary edema jama pediatrics jama network. Reexpansion pulmonary edema rpe is a rare complication that. Reexpansion pulmonary edema rpe is a rare form of noncardiogenic pulmonary edema that can result after prompt reexpansion of a chronically collapsed lung lobe. We report herein a case of repe caused by difficulties encountered with anesthesia using hfjv during videoassisted thoracic surgery vats for a spontaneous pneumothorax. Reexpansion pulmonary edema is an uncommon complication of the treatment of lung atelectasis, pleural effusion or. Reexpansion pulmonary edema following a posttraumatic. Contralateral reexpansion pulmonary edema with ipsilateral. The relationship between pleural pressures and changes in pulmonary function after therapeutic thoracentesis. We present a rare case in which a 57yearold korean man had a large amount of malignant pleural effusion. We describe the case of a patient suffering from reexpansion pulmonary edema rpe after chest drainage for pneumothorax.
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