title: Reexpansion pulmonary edema after surgery for spontaneous pneumothorax in a patient with anorexia nervosa.
abstract: BACKGROUND
  Several adverse effects on the pulmonary system in patients with anorexia nervosa (AN) have been reported. We present a case of AN who presented with a complicated reexpansion pulmonary edema (RPE) after video-assisted thoracic surgery (VATS) for spontaneous pneumothorax.
  
  
  METHODS
  A 23-year-old woman with severe anorexia nervosa (weight: 25 kg, body mass index: 8.96 kg/m(2)) underwent VATS for spontaneous pneumothorax. Five hours after the surgery, she immediately presented acute cardiorespiratory insufficiency. Chest radiography showed an infiltrating shadow in the entire right lung. She was diagnosed with reexpansion pulmonary edema that was treated with methylprednisolone pulse therapy and mechanical ventilation. She recovered and was extubated on postoperative day 4. The chest drain tube was removed on postoperative day 5.
  
  
  CONCLUSIONS
  Bullectomy or ligation of bullae for spontaneous pneumothorax in a patient with AN has never been reported. In our case, bullae were identified in preoperative CT and we chose ligation of the bullae instead of the bullectomy using automatic suture device because of poor wound healing concerned.
  
  
  CONCLUSIONS
  We present a case of RPE after VATS for spontaneous pneumothorax in a patient with AN. Malnutrition owing to AN results in critical complications such as RPE.
authors.affiliation: Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ozawa
authors.affiliation: Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Ichimura
authors.affiliation: Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sakai
keywords: AN, anorexia nervosa; Anorexia nervosa; Complications; Pneumothorax; RPE, reexpansion pulmonary edema; Reexpansion pulmonary edema; Surgery; VATS, video-assisted thoracoscopic surgery