Reexpansion pulmonary edema

Background

Incidence may be as low as 1% or as high as 14%[1]

Risk Factors

Poorly understood, but may include:

PTX > 30% in size
PTX symptoms for prolonged time, >3 days

Prevention

Consider using smaller bore chest tubes
Other strategies include applying water seal only or attaching only a Heimlich valve without suction

Clinical Features

Typically progresses over 2 days immediately after thoracentesis
- After 2 days, subsequent rapid improvement

Differential Diagnosis

Pulmonary Edema Types

Noncardiogenic pulmonary edema

Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion pulmonary edema
- Strangulation
Neurogenic causes
Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Inhalation injury
- Pulmonary contusion
- Aspiration pneumonia and pneumonitis
Other
- High altitude pulmonary edema
- Hypertensive emergency
- ARDS
- Sympathetic crashing acute pulmonary edema (SCAPE)
- Immersion pulmonary edema
- Hantavirus pulmonary syndrome
- Missed dialysis in kidney failure

Evaluation

Bilateral re-expansion pulmonary edema seven hours after thoracentesis for right pneumothorax. Reveals mixed ground-glass opacity and minimal consolidation combined with intralobular reticulations and interlobular septal thickening; Note tip of chest tube (arrowhead).

Radiographic opacities in previously collapsed lung

Management

Supportive, as is with other forms of noncardiogenic pulmonary edema
- If a patient requires intubation, positive pressure ventilation improves symptoms after 24-48 hours

Disposition

External Links

References

Mukhopadhyay A, Mitra M, Chakrabati S. Reexpansion pulmonary edema following thoracentesis. J Assoc Chest Physicians [serial online] 2016 [cited 2018 Oct 11];4:30-2. Available from: http://www.jacpjournal.org/text.asp?2016/4/1/30/159871.

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[1] Mukhopadhyay A, Mitra M, Chakrabati S. Reexpansion pulmonary edema following thoracentesis. J Assoc Chest Physicians [serial online] 2016 [cited 2018 Oct 11];4:30-2. Available from: http://www.jacpjournal.org/text.asp?2016/4/1/30/159871.