Reexpansion pulmonary edema

Background

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

Risk Factors

Poorly understood, but may include:

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

Prevention

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

Clinical Features

  • Typically progresses over 2 days immediately after thoracentesis
    • After 2 days, subsequent rapid improvement

Differential Diagnosis

Pulmonary Edema Types

Cardiogenic pulmonary edema

Noncardiogenic pulmonary edema

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

Disposition

See Also

External Links

References

  1. Mukhopadhyay A, Mitra M, Chakrabati S. Reexpansion pulmonary edema following thoracentesis. J Assoc Chest Physicians [serial online] 2016 [cited 2018 Oct 11];4:30-2. Available from: http://www.jacpjournal.org/text.asp?2016/4/1/30/159871.

Authors:

Ross Donaldson