title: Delayed onset of contralateral pulmonary edema following reexpansion pulmonary edema of a collapsed lung after video-assisted thoracoscopic surgery.
abstract: This case report describes a 61-year-old man who developed reexpansion pulmonary edema (RPE) of the collapsed left lung after video-assisted thoracoscopic surgery because of left thoracic empyema, complicated with secondary contralateral pulmonary edema later. The left lung was gently reexpanded after surgery under one-lung ventilation anesthesia for 2.5 hours. The patient developed RPE of the left lung immediately after surgery, and required mechanical ventilation with positive end-expiratory pressure support. RPE was resolved within 24 hours. Nevertheless, delayed onset of contralateral pulmonary edema manifested on chest radiography 4 days later without clinical symptoms such as tachypnea or dyspnea. There was no evidence of pulmonary infection, fluid overload, postoperative renal insufficiency or cardiogenic onslaught. Late manifestation of contralateral pulmonary edema in the wake of previous left-sided RPE was suspected from exclusion of possible culprits. Response to steroid therapy made inflammation-related pulmonary edema a likely diagnosis. This case demonstrates that delayed contralateral pulmonary edema with only radiographic evidence can emerge 4 days after resolution of RPE of a collapsed lung. Methods to prevent RPE and management of one-lung ventilation are described.
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C.
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Chang
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Hung
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chang
authors.forename: Kuang-Cheng
authors.initials: KC
authors.lastname: Chan
authors.forename: Hui-Yen
authors.initials: HY
authors.lastname: Chen
authors.forename: Shou-Zen
authors.initials: SZ
authors.lastname: Fan
authors.forename: Tzu-Yu
authors.initials: TY
authors.lastname: Lin
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D001261:Pulmonary Atelectasis / Q000150:complications*; D011654:Pulmonary Edema / Q000209:etiology*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*; D013997:Time Factors