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Acta Radiologica

ISSN: 0284-1851 (Print) 1600-0455 (Online) Journal homepage:

Re‐expansion Pulmonary Edema

A. Murat, A. Arslan & A. E. Balcı

To cite this article: A. Murat, A. Arslan & A. E. Balcı (2004) Re‐expansion Pulmonary Edema, Acta
Radiologica, 45:4, 431-433

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Published online: 09 Jul 2009.

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REPE Anıl Arslan. School of Medicine. anil_arslan@hotmail. After placement of a chest tube the chest radiograph was normal. a large pneumothorax.. following pleural effusion Fig. Following drainage leading to increased capillary permeability (5). Risk factors.45: 431–433. The mechanism is obscure. MURAT. of a pneumothorax or a large pleural effusion. Re-expansion pulmonary edema. BALCI Department of Radiology and Department of Thoracic Surgery. Chest radiograph shows completely collapsed right-side pneumothorax with REPE of the lung. A. School of Medicine. Key words: Pneumothorax. Department of Radiology. Acta Radiol 2004. or even during single-lung ventilation. DOI 10. M. sion with severe atelectasis (10). some authors and potentially lethal complication of thoracostomy suggest it is related to surfactant depletion. others tube placement for pneumothorax or pleural effu.D. 23119 Elazig. the right lung being fully re-expanded. Re-expansion pulmonary edema (REPE) is an uncommon complication following re-expansion of the lung as treatment of conditions such as hemopneumothorax. and long duration of collapse. Balci AE. that it results from hypoxic capillary damage. Arslan A. pneumothorax. The etiology of REPE remains speculative. 1. Turkey (fax. and after lobectomy. re-expansion pulmonary edema. CASE REPORT ACTA RADIOLOGICA Re-expansion Pulmonary Edema A. A. including young age. Firat University. Firat University. may help predict the patients that might encounter this complication. the The fact that REPE is concentrated mainly in the re-expanded lung can become acutely edematous re-inflated lower lobes. e-mail. although it is thought to be caused by increased pulmonary capillary permeability. B. Turkey Murat A. Elazig. ARSLAN & A. large pleural Accepted for publication 19 February 2004 Re-expansion pulmonary edema (REPE) is a rare (9). The majority of REPE complications are associated with treatment of spontaneous pneumothorax.1080/02841850410005624 # 2004 Taylor & Francis . E. z90 424 237 67 73.

has led to the conclusion that hypoxic The patient’s chest radiograph showed a right- damage. showing A 28-year-old man presented at hospital with a 1. ing. A chest radiograph revealed widespread alveolar consolida- tion of the right lung as evidence of unilateral Case Report pulmonary edema (Fig.432 A. B. 2C). Chest radiograph 28 h later shows that the pulmonary edema has cleared completely. A. side pneumothorax with complete collapse of the nant mechanism (12). increased attenuation of the lung parenchyma. 2B). Murat et al. rather than mechanical stress. the chest radiograph was normal (Fig. a chest radio- graph revealed severely increased opacity of large areas of the right lung (pulmonary edema). aspiration. The vital signs were edema) on the right side. The rest of the REPE. Fig. ary edema had cleared completely (Fig. and even tube thoracostomy. and became tachycardic and tachypneic. is the domi. Its onset can be sudden and right lung (Fig. Hypoxemia. the pulmon- physical examination was normal. C. Chest examination was notable for absent radiologic signs the patient was diagnosed as having breath sounds over the right chest. Computed tomography shows areas of consolidation and ground-glass opacities (pulmonary edema) of the right lung. The patient was treated with dramatic (10). Acta Radiol 2004 (4) . 1B). Computed tomography (CT) of the lungs was performed (Fig. 2. 1A). REPE is position. After the tube was placed in death have been observed in case series. with mortality estimates as high Two hours later the patient developed severe cough- as 20% (3). 2A). Two hours after the tube was placed. with week history of right-sided chest pain and dyspnea large areas of ground-glass opacity (pulmonary which had occurred suddenly. potentially lethal. With these clinical and normal. hypotension. At chest radiography 28 h later.

ment of recurrent pneumothorax (7).63:1206–7. Mak KH. returns to the now fully expanded lung (10). Hix WR. Exceptional pulmonary edema after re-expansion of spontaneous cases of recurrent edema are reported with treat. Nomimura T. the rapidity at and review of the current literature. Ann Thorac Surg 1988.30:1110–1. It has 5. The lism. pulmonary capillary permeability (1).93:828–31. Tarver RD. Updated in 1997. Acta Radiol 2004 (4) . Miller WC. related mechanical injury to the alveolar-capillary Kakehashi M. Reexpansion The clinical picture of REPE can be dramatic. Matsuura Y. the majority of tions for preventing or reducing such complication cases are associated with treatment of spontaneous in high-risk patients are supplemental oxygen. e. Chest 1991. Focal reexpansion pulmonary edema patient becomes tachypneic and tachycardic as after drainage of large pleural effusions: clinical evidence hypoxia increases. Reexpansion pulmonary edema due to high-frequency jet ventilation: encountering this complication (6). including young age. Reexpansion pulmonary edema: a case report to the size of the pneumothorax. Surg Today 2000.86:784–6. 4. Rapid high-risk patients by taking repeated radiographs reperfusion of a lung. uncommonly. Rarely. Am Rev Respir Dis 1988. et al. Ward BJ. Shaw TJ. Chest 1984. Aaron BL. Onset usually occurs immediately following lung Reexpansion pulmonary edema. Aaron BL. Young patients (under 40 edema. a References large pneumothorax. Caterine JM. 12. Scott CS. Ann re-expansion. and longer duration of collapse. 9. Severe coughing often after thrombolytic therapy of massif pulmonary embo- heralds the development of pulmonary edema. Risk factors. 4).24:23–7. Matsushima T. REPE most commonly occurs in the lung during treatment of conditions such as the treatment of patients with a large pneumo- hemopneumothorax. J Thorac Imaging 1996. 3. Palat H. The etiology of REPE remains speculative.g. Mahfood S. In many patients. may also cause acute pulmonary edema (11). 10. Am Rev Respir Dis 1973.100:1562–6. REPE can be diagnosed and treated earlier in rare complication of tube thoracostomy (4). Tan HC. An inflam. REPE occurs. REPE after spontaneous pneumothorax is a 4). following expansion of In conclusion. Heller BJ. Watson DC. Murakami H. massive pulmonary embolus or following thrombo- endarterectomy. slow pneumothorax (8). drainage. duration of symptoms before radiologic detection 7. South Med J 2000. Fujino S. Inoue S. Woodring JF.90:1176–82. Hix WR. Reexpansion pulmonary edema. Toon R. 2. Some sugges- single-lung ventilation. Wang YT. Trachiotis GD. All reported patients became sym. Grathwohl MK.108:664–6. J Emerg Med which the pneumothorax is drained. Clinical analysis of reexpansion membrane and reperfusion injury as blood flow pulmonary edema. 8. or thorax of longer duration. by aspiration with a high negative pressure. Contralateral reexpansion although it is thought to be caused by increased pulmonary edema. Cardiac output increases prior to development of although this is not always the case. Tezuka N. pulmonary edema. However.138:1308–11. with 64% of patients exhibiting symp. Reperfusion pulmonary edema ptomatic within 24 h (3). toms within 1 h. Conces DJ. a large pleural effusion. Blaes P. after thrombolysis of a and by careful monitoring of the clinical condition. Pearse DB. South Med J 1997. rapid expansion is caused monary edema. and avoidance of continuous suction (3. matory response occurring when the lung re. Experimental pulmonary been reported in several case series that the edema following re-expansion pneumothorax.11:198–209. but remains a rare pneumothorax. Vricella LA. Johan A. expands is believed to be secondary to expansion.45:340–5. may help predict the patients at risk of 1. and the 2003. Respir Med 2002. Kajihara H. after lobectomy or even during complication of tube thoracostomy. bilateral or contralateral suggesting hypoxic injury to the lung as the cause of edeme develops (2). Re-expansion Pulmonary Edema 433 Discussion years) have been reported to be at greater risk of developing REPE (4). Broderick LS. 11.96:461–5. likelihood of developing REPE is directly related 6. report of a case. pneumothorax. Thorac Surg 1997. Poh SC. Recurrent re-expansion pul- (3.