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Weekly Chest CasesArchive of Old Cases

Case No : 167 Date 2001-01-06

  • Courtesy of Yookyung Kim, MD / Eulji College Hospital, Taejon, Korea
  • Age/Sex 32 / M
  • Chief ComplaintHospitalized due to dyspnea, cough, and chest pain for two weeks. Progressive dyspnea after placement of a chest tube. Fig. 1. Initial chest radiograph Fig. 2. 10 hours after placement of a chest tube
  • Figure 1
  • Figure 2

Diagnosis With Brief Discussion

Diagnosis
Reexpansion Pulmonary Edema
Radiologic Findings
Fig.1. Initial chest radiograph shows large right pleural effusion and marked left mediastinal displacement.

Fig. 2. Chest radiograph immediately after placement of the chest tube (10 hr after pleurocentesis) demonstrates diffuse consolidations of both lungs. The right pleural effusion was almost evacuated.
Brief Review
Reexpansion pulmonary edema is a rare complication attending the rapid reexpansion of a chronically collapsed lung, such as occurs after evacuation of a large amount of air or fluid from the pleural space.

As a rare occasion, it may also develop after reexpansion of collapsed lung by laser bronchoscopic resection of occlusive endobronchial tumor.

The condition usually appears unexpectedly and dramatically-immediately or within 1 h in 64% of patients and within 24 h in the remainder.

The clinical manifestations are varied; they range from roentgenographic findings alone in asymptomatic patients to severe cardiorespiratory insufficiency.

The radiographic evidence of reexpansion pulmonary edema is a unilateral alveolar filling pattern, seen within a few hours of reexpansion of the lung.

The edema may progress for 24-48 h and persist for 4-5 days.

The pathophysiology of reexpansion pulmonary edema remains obscure.
Various hypotheses regarding the mechanism of reexpansion pulmonary edema include
1. increased pulmonary capillary permeability due to hypoxic injury,
2. decreased surfactant production, and
3. altered pulmonary perfusion and mechanical stretching of membranes.

Reexpansion pulmonary edema usually occurs in ipsilateral lung reexpanded following pleurocentesis, but rarely bilateral pulmonary edema may occur following unilateral pleurocentesis.

Ragozzino et al. (2) hypothesized that reexpansion pulmonary edema can involve the opposite lung when there is significant contralateral lung compression.

Removal of the large volume of fluid or air results in acute reexpansion of both lungs.

Thus, the potential mechanisms that alter capillary permeability are present bilaterally.

Treatment is basically preventive.

Only supportive therapy can be offered once reexpansion pulmonary edema has developed.

Several clinical prognoses have been reported in the literature with a 15 to 20% mortality despite use of mechanical ventilation in particularly serious situations.
References
1. Traver RD, Broderick LS, Conces DJ Jr. Reexpansion pulmonary edema. J Thorac Imaging 1996; 11:198-209

2. Ragozzino MW, Greene R. Bilateral reexpansion pulmonary edema following unilateral pleurocentesis. Chest 1991; 99:506-508

3. Ben M'Rad S, Baccar MA, Azzabi S, Aouina H, Bouacha H. Reexpansion pulmonary edema. Rev Pneumol Clin 1999; 55:105-108
Keywords
Lung, Edema, Permeability edema,

No. of Applicants : 41

▶ Correct Answer : 41/41,  100.0%
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  • - 瑜˜李쎌š
  • - 11th Air Force Hospital Byung-June Jo
  • - CHU Nancy-Brabois France Denis Regent
  • - Dong-A university Hospital Ki-Nam Lee
  • - Dongkang Hospital Kim Won Ho
  • - Gachon Medical School Gil Medical Center Seo Joon Beom
  • - Matsuyama Red Cross Hospital, Matsuyama, Japan Shunya Sunami
  • - Ospedale di Fabriano, Italy Giancarlo Passarini
  • - Seoul National University Hospital Tae Jung Kim
  • - Seoul National University Hospital Chung Myung Jin
  • - SRI GOKULAM HOSPITALS, SALEM VILVENDHAN RAJENDRAN
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
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