New classification and clinical characteristics of reexpansion pulmonary edema after treatment of spontaneous pneumothorax.
OBJECTIVE
Reexpansion pulmonary edema (REPE) is a rare yet sometimes fatal complication associated with the treatment of lung diseases such as pleural effusion, pneumothorax, and hemothorax. The current study summarizes our experience with REPE for a 3-year period.


METHODS
We prospectively collected demographic and clinical data on consecutive patients presenting to an academic university-based emergency department with spontaneous pneumothorax that was treated with closed thoracostomy for a 3-year period.


RESULTS
Eighty-four study patients were enrolled between December 2002 and September 2005. Reexpansion pulmonary edema developed in 25 of 84 (29.8% [95% confidence interval, 21.0-40.2]) patients. Many cases of REPE were small and asymptomatic and only diagnosed on computed tomography of the chest. There was only one death (1.2% [95% confidence interval, A to B]). Reexpansion pulmonary edema was associated with patients with larger pneumothoraces without fibrotic changes and with patients with hypoxia and fibrotic changes. Classic REPE as seen on chest radiograph was 16 (19.0%) in 84 patients. Diffuse REPE as seen only on computed tomography and involved more than 1 lobe was 1 (1.2%) in 84 patients. Isolated REPE as seen only on computed tomography and limited to lesser than 1 lobe was 8 (9.5%) in 84 patients.


CONCLUSIONS
The rate of REPE after tube thoracostomy of spontaneous pneumothorax is greater than previously reported and often asymptomatic. The risk of developing REPE is greater with larger pneumothorax, especially in patients without fibrotic lung changes, and with hypoxia in patients with fibrotic changes.
Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea.
Yun Kwon
YK
Kim
Hyun
H
Kim
Christopher C
CC
Lee
Han Joo
HJ
Choi
Kang Hyun
KH
Lee
Sung Oh
SO
Hwang
Joong Hwan
JH
Oh
Young Han
YH
Lee
Adam J
AJ
Singer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000601:surgery*; D011183:Postoperative Complications / Q000145:classification* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000145:classification* / Q000000981:diagnostic imaging / Q000453:epidemiology; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013907:Thoracostomy; D014057:Tomography, X-Ray Computed