Reexpansion pulmonary edema

Background

• Incidence may be as low as 1% or as high as 14%

Risk Factors

Poorly understood, but may include:

• PTX > 30% in size
• PTX symptoms for prolonged time, >3 days
• Type 2 DM

Prevention

• Consider using smaller bore chest tubes
• Other strategies include applying water seal only or attaching only a Heimlich valve without suction

Clinical Features

• Unilateral pulmonary edema presenting within minutes to hours after thoracentesis or other rapid thoracic decompression
  • Patients will generally present with acute onset dyspnea, cough, hypoxemia, tachycardia
    • Potentially fatal complication

Differential Diagnosis

Pulmonary Edema Types

Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema

• Cardiogenic pulmonary edema
• Noncardiogenic pulmonary edema
  • Negative pressure pulmonary edema
    • Upper airway obstruction
    • Reexpansion pulmonary edema
    • Strangulation
  • Neurogenic causes
    • Seizure
    • Head trauma
    • Subarachnoid hemorrhage
    • Electrocution
  • Iatrogenic fluid overload
    • Multiple blood transfusions
    • IV fluid
    • Inhalation injury
    • Pulmonary contusion
    • Aspiration pneumonia and pneumonitis
  • Other
    • High altitude pulmonary edema
    • Hypertensive emergency
    • ARDS
    • Flash pulmonary edema
    • Immersion pulmonary edema
    • Hantavirus pulmonary syndrome
    • Missed dialysis in kidney failure
    • Naloxone reversal

Evaluation

Bilateral re-expansion pulmonary edema seven hours after thoracentesis for right pneumothorax. Reveals mixed ground-glass opacity and minimal consolidation combined with intralobular reticulations and interlobular septal thickening; Note tip of chest tube (arrowhead).

• Radiographic opacities in previously collapsed lung

Management

• Supportive, as is with other forms of noncardiogenic pulmonary edema
  • If a patient requires intubation, positive pressure ventilation improves symptoms after 24-48 hours

See Also

• Chest tube
• Pneumothorax
• Needle thoracostomy