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| Chief complaint | A young male with dyspnea for 1 day. |
|---|---|
| Age | 18yrs |
| Sex | Male |
| Modality | CT,Plain film/Xrays |
| System | Chest |
Prince of Songkla University
Prince of Songkla University
Spontaneous right pneumothorax from lung bleb
Post percutaneous chest drainage (PCD), the patient developed dyspnea and cough. HRCT was done, after performing right percutaneous drainage for 4 days. The HRCT showed mutifocal ill-defined ground-glass opacities and consolidations, scattered in the subpleural part of the right lung - likely residual re-expanding edema.
Re-expansion pulmonary edema (REPE) is uncommon iatrogenic complication, following the re-expansion of the lung after performing the procedure such as thoracentesis, intercostal drainage (ICD), or percutaneous drainage (PCD) for large amount of pneumothorax, or pleural effusion at least 1.2 L/8 hours. The incidence is about 1% and the mortality rate can reach up to 20%.
The greatest risk affects young patients with extensive pneumothorax or pulmonary collapse of more than 7 days, or in patients with large pleural effusion in which the volume of fluid removed is > 3 L. It might occur within one or two hours after the procedures. Patient may experience dyspnea, thoracic pain, cough with or without pink/foamy sputum, or may be asymptomatic.
REPE can worsen for one to two days and usually resolve several days later. Contralateral REPE is rarely found. The pathophysiology of REE includes reperfusion injury of the hypoxic lung, increased capillary permeability, and local production of neutrophil chemotactic factors.
References
1. Stawicki, Stanislaw P. pulmonary edema. International Journal of Academic Medicine 3, May 2017.
2. Saade Mahfood, Reexpansion Pulmonary Edema, The Annals of Thoracic Surgery, Volume 45, Issue 3, 1988.
3. Cusumano G, Re-Expansion Pulmonary Edema as a Life-Threatening Complication in Massive, Long-Standing Pneumothorax: A Case Series and Literature Review. Journal of Clinical Medicine. 2024; 13(9):2667.
4. Kraipop W, Re-expansion Pulmonary Syndrome after Hemothorax: A Case Report of Contralateral Pulmonary Edema, VOL. 37 NO. 1 (2016). 5. Kasmani R, Re-expansion pulmonary edema following thoracentesis. CMAJ. 2010;182(18).
6. Dias OM, Reexpansion pulmonary edema after therapeutic thoracentesis. Clinics (Sao Paulo). 2010;65(12).
