[Reexpansion pulmonary edema after removal of a giant thoracic tumor associated with long-time lung collapse and mediastinal shift].
A 64-year-old woman was admitted to our hospital for removal of a thoracic tumor. Chest X-ray and computed tomography demonstrated a giant thoracic tumor occupying the right thorax, with the right lung almost completely collapsed and the mediastinum shifted to the left. Her preoperative pulmonary function studies revealed %vital capacity of 30%, and her oxyhemoglobin saturation was 92% (room air). Anesthesia was maintained with sevoflurane and fentanyl. The trachea was intubated with an armored tube because of severe tracheal shift. Operation was performed in the supine position. A Swan-Ganz catheter was inserted from the right femoral vein under fluoroscopy with stand-by of percutaneous cardiopulmonary support. The tumor was removed segmentally, and her right lung was inflated gradually. Two hours after removal of the tumor, PaO2 decreased to 74.2 mmHg (FIO2 1.0), and a large amount of sputum was suctioned subsequently. We suspected re-expansion pulmonary edema (RPE) and administered steroid with frequent tracheal suctioning. The patient was transferred to ICU without extubation. Postoperative X-ray demonstrated diffuse alveolar infiltrates over the right lung field. The patient was followed by respiratory management and body fluid management with diuretic drugs. The trachea was extubated on the following day, and her postoperative recovery was uneventful thereafter. We should consider the occurrence of RPE at removal of the giant thoracic tumor.
Otomo
Asae
A
Department of Anesthesiology, National Cancer Center, Tokyo 104-0045.
Kawatani
Masako
M
Morikawa
Tomoko
T
Nakazawa
Kouichi
K
Makita
Koshi
K
D000768:Anesthesia, General; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000628:therapy; D007442:Intubation, Intratracheal; D008477:Mediastinal Diseases / Q000150:complications*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011182:Postoperative Care; D001261:Pulmonary Atelectasis / Q000150:complications*; D011654:Pulmonary Edema / Q000209:etiology* / Q000628:therapy; D013899:Thoracic Neoplasms / Q000150:complications* / Q000601:surgery*