RE-EXPANSION PULMONARY

EDEMA
Awan Rochaniawan
 DEFINITION
• Re-expansion pulmonary edema (REPE) is an
uncommon complication that occurs in
patients suffering from lung collapse,
especially in cases of extensive and long-term
pneumothorax or pleural effusion.
• It is a rare but potentially fatal (mortality up to
20%) complication of the rapid removal of air,
fluid, or other space-occupying lesion from the
pleural cavity.
• Temporal sequence of chest X-ray imaging of the patient suffering from re-expansion pulmonary edema (REPE).
• (a) Chest X-ray showing normalpulmonary field of both hemithorax after injury.
• (b) Chest X-ray showing large right pneumothorax (estimated 85%) with collapsed right lung and contralateralmediastinal
deviation.
• (c) Chest X-ray showing most of the right lung has been re-expanded, accompanied by massive exudative change.
• (d) Chest X-ray showingbilateral clear lungs with free pleural space after 3 days of treatment.
 PATHOPHYSIOLOGY
• The precise pathophysiology underlying re-
expansion pulmonary oedema has not been
clearly established, but alterations of vascular
permeability and hydrostatic mechanisms are
thought to be involved.
• Histological abnormalities of the pulmonary
microvessels as well as mechanical stress
exerted during reexpansion are implicated in
the pathogenesis of this disorder.
 RISK FACTORS
1. Pulmonary collapse for longer than 1 week
2. Younger age
3. Rapid removal of a large amount of pleural
fluid over a short time period  the
recommended rate of removal of 1–2 L
every 2 h should not be exceeded.
 TREATMENT
• A good outcome can be expected from
symptomatic therapy and procedures that
reduce the level of mechanical stress during
reexpansion.
• Treatment is generally conservative and
supportive.
THANK YOU
 REFERENCES
• Petiot, A., Tawk, S., & Ghaye, B. (2018). Re-expansion
pulmonary oedema. The Lancet, 392(10146), 507.
doi:10.1016/s0140-6736(18)31722-7
• Chakraborty, P., Chakraborty, S. (2012). Indian Journal of
Surgeon 74(2):174–176. doi: 10.1007/s12262-011-0258-x
• Zabielna J Med Case Reports (2021) 15:510
https://doi.org/10.1186/s13256-021-03112-w
• He Fang, Long Xu, Feng Zhu, Zhaofan Xia, Re-expansion
pulmonary edema post-pneumothorax, Burns & Trauma,
Volume 8, 2020, tkaa032,
https://doi.org/10.1093/burnst/tkaa032