Ipsilateral reexpansion pulmonary edema after drainage of a spontaneous pneumothorax: a case report

Reexpansion pulmonary edema after drainage of pneumothorax

Reexpansion pulmonary edema is a rare complication of thoracocentesis with mortality rates as high as 20%. It presents with tachycardia, hypotension, and hypoxemia within hours after thoracocentesis. The exact pathophysiology is not known. The risk factors for the same should be carefully assessed and considered before chest tube drainage. The treatment is supportive. A case of ipsilateral reexpansion pulmonary edema after chest tube drainage of spontaneous pneumothorax is described and illustrated. He was managed with noninvasive ventilation, inotropes, and other supportive treatment and recovered completely.

Re-expansion pulmonary oedema - differential lung ventilation comes to the rescue

Re-expansion pulmonary oedema (REPE) is a rare complication following re-inflation of a chronically collapsed lung, which is often fatal. We present a case of a 22-year-old male who presented to the hospital with severe respiratory distress and a history of blunt abdominal trauma 3 months back. He was diagnosed to have left sided diaphragmatic hernia with a mediastinal shift to the right, and was posted for emergency repair of the same. After surgical decompression of the left hemi-thorax and reduction of the abdominal contents, re-expansion of the left lung was achieved, following which patient developed REPE. A left sided double lumen tube was then inserted to prevent flooding and cross contamination of the right lung and ventilation of both lungs was maintained intraoperatively. Post-operatively, REPE was successfully managed by differential lung ventilation with a lung salvage strategy to the left lung and a lung protective strategy to the right lung.

Reactive species and pulmonary edema

Pulmonary edema occurs when fluid flux into the lung interstitium exceeds its removal, resulting in hypoxemia and even death. Noncardiogenic pulmonary edema (NPE) generally results when microvascular and alveolar permeability to plasma proteins increase, one possible etiology being oxidant injury. Reactive oxygen and nitrogen species (RONS) can modify or damage ion channels, such as epithelial sodium channels, which alters fluid balance. Experimental systems in which either RONS are increased or protective antioxidant mechanisms are decreased result in alterations of epithelial sodium channel activity and support the hypothesis that RONS are important in NPE. Both basic and clinical studies are needed to critically define the RONS-NPE connection and the capacity of antioxidant therapy (either alone or as a supplement to β-agonists) to improve patient outcome.

Re-expansion pulmonary edema in a patient with total pneumothorax: a hazardous outcome

Re-expansion pulmonary edema (REPE) is a rare complication of treatment of spontaneous pneumothorax or large pleural effusions. As a complication of spontaneous pneumothorax treatment, only few cases are documented, and even fewer document the role of non-invasive continuous positive airway pressure mechanical ventilation for treatment of this rare entity. We present a case of 23-year-old man who presented with left-sided pneumothorax, developed unilateral REPE and was treated with non-invasive continuous positive airway pressure.

A simple chest drain gone wrong: a near miss!

This is a case of a 45-year-old woman, with known alcoholic liver disease who presented with a large right-sided pleural effusion. A pleural tap was performed followed by insertion of an intercostal drain. 7 litres were drained over 4 h and only 300 ml of 20% albumin were administered with the patient becoming acutely short of breath and requiring admission to the intensive treatment unit due to the development of the known and recognised complication of re-expansion pulmonary oedema. The patient required continuous positive airway pressure in an intensive care setting but made a good recovery. It is important to consider re-expansion pulmonary oedema in patients who become acutely short of breath during drainage of pleural fluid or air. Steps should be made to ensure that drainage of large volumes of fluid are performed in a controlled manner to avoid this preventable complication.

Reexpansion pulmonary edema

A reexpanziós tüdőödéma (RPE) egy ritkán előforduló kórállapot, amely rendszerint a krónikusan kollabált tüdő reexpanziója után jelentkezik. A klinikai manifesztáció széles skálán mozog a tünetmentes betegtől a halálos kimenetelig, amely utóbbi akár az esetek 20%-ában is előfordulhat. A patofiziológiai háttér komplex és máig nem teljesen tisztázott. Az ismert kockázati tényezők szem előtt tartásával és azok lehetőség szerinti kiküszöbölésével akár el is kerülhető az RPE kialakulása. Ez az összefoglaló megpróbál áttekintést adni a jelenlegi ismereteinkről, az RPE hátteréről, a terápiás lehetőségekről. Orv. Hetil., 2010,41,1708–1711.

Resolution of persistent pneumothorax by use of blood pleurodesis in a dog after surgical correction of a diaphragmatic hernia

CASE DESCRIPTION

A 15-kg (33-lb) pregnant female mixed-breed dog of unknown age was referred because of a 10-day history of difficulty breathing.

CLINICAL FINDINGS

Physical examination findings were dyspnea, tachypnea, decreased bronchovesicular sounds (bilateral), muffled heart sounds, and abdominal distention with palpable fetuses. Hematologic abnormalities included anemia, leukocytosis, and thrombocytosis. Abnormalities detected during serum biochemical analysis included decreases in concentrations of albumin, sodium, triglycerides, and total calcium and increases in activities of alkaline phosphatase, alanine aminotransferase, gamma-glutamyltransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. Thoracic radiography revealed a diaphragmatic hernia with fetuses and a soft tissue or fluid opacity within the thoracic cavity.

TREATMENT AND OUTCOME

Exploratory celiotomy, ovariohysterectomy, partial sternotomy, placement of a right-sided thoracostomy tube, and herniorrhaphy were performed. After surgery, pneumothorax developed, and the thoracostomy tube was used to remove pleural effusion and free air. The pneumothorax did not resolve after continuous drainage of the thoracic cavity for 4 days. Autologous blood pleurodesis was performed by infusion of 80 mL (6 mL/kg [2.73 mL/lb]) of whole blood. The pneumothorax resolved immediately after injection of the blood.

CONCLUSIONS AND CLINICAL RELEVANCE

Blood pleurodesis was used for resolution of pneumothorax in a dog after correction of a diaphragmatic hernia. Blood pleurodesis may provide a simple, safe, and inexpensive medical treatment for resolution of persistent (duration>5 days) pneumothorax when surgery is not an option.

Fulminant unilateral pulmonary edema after insertion of a chest tube: a complication after a primary spontaneous pneumothorax

INTRODUCTION

The insertion of a chest tube in cases of large pleural effusion or spontaneous pneumothorax is a common surgical procedure often performed by a physician in training under the supervision of a senior physician.

CASE PRESENTATION

The authors report the case of a 35-year-old man with a persistent, complete spontaneous pneumothorax of approximately 30 hours' duration. Within 90 minutes after insertion of a chest tube, he developed severe unilateral pulmonary edema and required mechanical ventilation. FINDINGS AND CLINICAL COURSE: Computerized tomography revealed severe, unilateral pulmonary edema referred to as re-expansion pulmonary edema. After emergency endotracheal intubation and mechanical ventilation with continuous positive airway pressure, the pulmonary edema resolved completely and the patient recovered.

CONCLUSION

Re-expansion edema is a rare, potentially life-threatening complication of the drainage of a spontaneous pneumothorax. With early recognition and timely treatment, complete resolution can be achieved. Risk factors include rapid re-expansion of the lung, young patient age, and a large pneumothorax persisting longer than 24 hours. If these risk factors are present, the chest tube should be inserted without primary suction. Doing so allows the lung to re-expand more slowly and may prevent this severe complication.