Reexpansion pulmonary oedema repe is described in the literature, mostly after drainage of more than approximately 1 l of fluid from the pleural space. They did retract the et tube and also put in a chest tube which was not nec. Histological abnormalities of the pulmonary microvessels in a chronically collapsed lung will cause rpe, as well as mechanical stress exerted during reexpansion. Reexpansion pulmonary edema rpe and ischemiareperfusion ir injury are now recognized as potentially fatal complications of surgical correction of tdh.
Reexpansion pulmonary edema the journal of the american. A number of factors have been identified that increase the risk of developing. One patient with reexpansion pulmonary edema is presented. Dec 14, 2010 reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. The patient recovered completely after 2 days of supportive treatment and a further chest xray. Reexpansion pulmonary edema after chest drainage for. We report a case of 46yearold male with simultaneous bilateral spontaneous tension pneumothorax. Reexpansion pulmonary edema is a noncardiogenic pulmonary edema that occurs in the setting of rapid expansion of a collapsed lung. Learning radiology reexpansion, reexpansion, pulmonary, edema. New treatment method for reexpansion pulmonary edema. Reexpansion pulmonary edema is an uncommon complication following drainage of a. This condition is a relatively unknown complication of intercostal chest drainage and is potentially lethal in 20% of cases.
Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural cavity performed by either thoracentesis or. There are many accounts of repe occurring in adults, but to my knowledge, this problem has not been reported in the pediatric population. In cardiogenic pulmonary edema, a high pulmonary capillary pressure as estimated clinically from the pulmonary artery wedge pressure is responsible for the abnormal fluid movement. Clinical presentations include cough, chest discomfort and. Thepathologicderangementlead ingto repe has not been character ized, but evidence suggests that in creased pulmonarycapillaryperme ability may be the primary aber ration. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition.
On the left, there is a large rightsided pneumothorax white arrows. This renewed interest is related to increased awareness rather than to any true rise. The incidence referred is less than 1%, and mortality can reach up to. Reexpansion pulmonary oedema repo constitutes a non rare complication with many not yet elucidating causative factors. Therefore, early recognition of signs and symptoms is important since inadequate or delayed. Reexpansion pulmonary oedema in pneumothorax bmj case reports. Reexpansion pulmonary edema is a rare complication that may occur after drainage of pneumothorax or pleural effusion. The precise pathophysiologic abnormalities associated with. Reexpansion pulmonary edema following thoracentesis. It results in acute onset shortness of breath that usually results within. The condition occurs in the setting of rapid expansion of a collapsed lung, with acute onset. Pdf prevention of reexpansion pulmonary edema and ischemia. The patient was admitted to the intensive care unit and remained stable with 30 lminute highflow nasal cannula for 2 days. Development of unilateral pulmonary edema in the reexpanded lung is a rare but recognized complication of evacuation of a pneumothorax and rapid pulmonary reexpansion.
This condition is recognized to occur more frequently in patients under the age of 40 years, but there has been no detailed analysis of reported pediatric cases of rpe to date. Largevolume thoracentesis and the risk of reexpansion pulmonary edema. Acute unilateral reexpansion pulmonary edema after. Reexpansion pulmonary edema pe is a rare complication of general thoracic surgery. Reexpansion pulmonary edema rpe is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of lung collapse. 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. The patient received supplemental oxygen via a nonrebreather face mask to compensate for hypoxemia. This renewed interest is related to increased awareness rather than to any true rise in the incidence of this welldescribed entity. Clinical presentations include cough, chest discomfort and hypoxemia. Repeated chest xray imaging revealed increased alveolar opacification of the. Reexpansion pulmonary oedema in pneumothorax bmj case. The patient recovered completely after 2 days of supportive treatment and a further chest xray showed clear lung fields bilaterally. 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.
Pdf reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Reexpansion pulmonary edema rpe is a lifethreatening but rare complication after reexpansion of a collapsed lung. Teixeira3, marcelo alexandre costa vaz3, evaldo marchi3 reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Reexpansion pulmonary edema radiology reference article. We describe the case of a patient suffering from reexpansion pulmonary edema rpe after chest drainage for pneumothorax. In cardiogenic pulmonary edema, a high pulmonary capillary pressure. Prevention of reexpansion pulmonary edema and ischemia. Pulmonary reexpansion edema may be considered an iatrogenic complication due to rapid emptying of the pleural cavity. Symptoms are usually noted within 24 hours after thoracentesis.
The et tube was lower on a film 4 hours prior to the first. Reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung. Risk factors for this condition include a young age, a long duration of lung. Dual purposes of this report are to remind physicians of the existence and natural history of this process, and to stimulate interest in research into its cause and management. Reexpansion pulmonary edema repe is an uncommon complication after reinflation of a collapsed lung. A number of factors have been identified that increase the risk of developing reexpansion pulmonary edema, and pathophysiologic mechanisms have been postulated. There exists some controversy about the exact incidence of reexpansion edema. Update reexpansion pulmonary edema eduardo henrique genofre1, francisco s.
Altogether 233 papers were found using the reported search, of which represented the best evidence to answer the clinical question. Reexpansion pulmonary edema after treatment of simultaneous. Reexpansion pulmonary edema the annals of thoracic surgery. Reexpansion pulmonary edema following thoracentesis cmaj. Over the last few years, considerable interest has been generated in the phenomenon of reexpansion pulmonary edema. The left lung was collapsed due to right main stem intubation. Reexpansion pulmonary edema after the insertion of a. Unilateral pulmonary edema, pneumothorax, pleural effusion. 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.
In this article, i present my views on the history, clinical features, morphophysiological features, pathogenesis, and treatment of rpe. A case of pulmonary edema following reexpansion of a collapsed lung due to pneumothorax is described and illustrated. Reexpansion pulmonary edema repe is an uncommon problem that afflicts the reexpanded lung after evacuation of a large pneumothorax or pleural effusion. Reexpansion pulmonary edema is an uncommon but important cause of noncardiogenic pulmonary edema. 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.
The total volume drained was calculated to be 55 l. Each developed reexpansion pulmonary edema during their first thoracentesis, followed by a pneumothorax during their second thoracentesis. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are implicated in the pathogenesis of this disorder. Severe reexpansion pulmonary edema developed after bilateral tube thoracoscomy.
We report a case of reexpansion pulmonary edema rpe following pleural. An hour after chest tube insertion red arrows, there is now airspace disease in the right lung yellow. Analysis of edema fluids and histologic features of the lung. Severe reexpansion pulmonary edema induced by onelung. Reexpansion pulmonary edema can be a complication of thoracentesis. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased. Pdf reexpansion pulmonary edema partha chakraborty. Teixeira3, marcelo alexandre costa vaz3, evaldo marchi3 reexpansion.
A best evidence topic in cardiac surgery was written according to a structured protocol. This condition is a relatively unknown complication of intercostal chest. Conclusion rpe is a rare complication occur after reexpansion of a collapsed lung develop within 24 hrs progress for 12 days resolve within 57 days references. Reexpansion pulmonary edema jama pediatrics jama network. The role of tissue reperfusion in the reexpansion injury of the lungs. Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion.
Rpe has been reported in humans and small animals when rapid reinflation of a chronically collapsed lung lobe via spontaneous ventilation or positivepressure. The relationship between pleural pressures and changes in pulmonary function after therapeutic thoracentesis. Introduction unilateral reexpansion pulmonary edema rpe is a complication described after a pleural drainage. Apr 08, 2011 reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. Reexpansion pulmonary edema is a rare form of acute lung injury following rapid re inflation of collapsed lung parenchyma. The incidence referred is less than 1%, and mortality can reach up to 20%.
The importance of recognizing this relatively uncommon phenomenon is stressed. Reexpansion pulmonary edema after therapeutic thoracentesis ncbi. Reexpansion pulmonary edema r eexpansion pulmonary edema rpe is an uncommon but potentially fatal complication after reexpansion of a chronically collapsed lung lobe in a dog or cat. As none of the procedures were technically complicated, an association can be suggested between these 2 rare complications. Reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly.
Differential lung ventilation sang rock cho, md, jeong sang lee, md, and mun soo kim, md department of thoracic and cardiovascular surgery, seoul city boramae. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of. Sep 29, 2007 we report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. 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.
From department of surgery, faculty of medicine, jichi. Mechanical stresses,surfactant abnormalities,neutrophil accumulation, ventilatorinduced injury,and ischemiareperfusion injury may all contribute. Potentially fatal rpe appears to be a greater risk in patients with chronic lung collapse, and cats are affected more often than dogs. Subsequently, the patient became hypoxic, requiring supplemental oxygen via nonrebreather mask. Reexpansion pulmonary edema after therapeutic thoracentesis. It is most commonly described with lung reexpansion after treatment of pneumothorax or. Based on the clinical and radiological findings, a diagnosis of reexpansion pulmonary oedema was made. The onset of pulmonary edema can be delayed by up to 24 hours in some cases.
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