[Re-expansion pulmonary oedema in a patient after treatment of pneumothorax].
In a 32-year-old man with left-sided pneumothorax, dyspnoea and tachypnoea with a drop in blood pressure and severe hypoxaemia recurred during drainage. The chest X-ray revealed an alveolar infiltrate in the middle and lower segments of the left lung that was interpreted as re-expansion pulmonary oedema. The patient was respirated and given extra fluids. Extubation was possible after four days. Re-expansion pulmonary oedema is a rare, potentially lethal complication after treatment of a collapsed lung due to a hydro- or pneumothorax. The oedema usually occurs in the re-expanded lung and must be considered when there is a sudden respiratory or haemodynamic deterioration after drainage of X fluid or air. The diagnosis is made by clinical examination and chest X-ray. Predisposing factors are a large hydro- or pneumothorax, long-term collapse, young age and rapid re-expansion. This complication can be prevented by low negative suction pressures and by aspirating a maximum of 1000 to 1500 ml of pleural fluid. The pathophysiology of re-expansion pulmonary oedema is not completely understood and is probably multifactorial. The treatment is merely supportive: oxygen, intravenous fluid substitution and if necessary artificial ventilation. The use of diuretics should be avoided in patients with hypotension.
Van Herendael
H E
HE
Sint-Elisabeth Ziekenhuis, Rubensstraat 166, 2300 Turnhout, België.
Van den Heuvel
M C
MC
Van Roey
G W
GW
Soetens
F M
FM
D000328:Adult; D015505:Chest Tubes / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007440:Intubation / Q000009:adverse effects*; D008168:Lung / Q000503:physiopathology*; D008297:Male; D011030:Pneumothorax / Q000150:complications / Q000628:therapy*; D011654:Pulmonary Edema / Q000209:etiology* / Q000517:prevention & control