PURPOSE: Reexpansion pulmonary edema (RPE), a rare but serious complication of tube thoracostomy for prolonged massive pneumothorax, has been well known because of its high mortality rate (21%). The clinical manifestations of RPE varies from cough, chest pain, lobar opacity to intolerable chest pain, intractable cough with expectoration of frothy sputum, hypoxemia, hypotension, even shock and opacification of one lung . Experience in management and decreasing the severity of RPE are presented.
METHODS: During the past five years, four patients with prolonged (more than three days) massive pneumothorax were treated. The first two patients (Group A) received tube thoracostomy (24 Fr) without suction; the later two patients (Group B) received pigtail catheter (12 Fr) connected with three-way stopcock for intermittent drainage. The post-drainage clinical manifestations and radiological findings are tools for evaluation of severity of RPE.
RESULTS: Group A developed moderate to severe clinical and radiological manifestations of RPE. The clinical manifestations subsided in hours after treatment, but radiological pattern of RPE persisted for days . Group B had radiological patterns consistent with RPE but only developed mild clinical symptoms of RPE.
CONCLUSION: 1. Tube thoracosatomy for the treatment of prolonged massive spontaneous pneumothorax may cause RPE even without applied suction.2. Expectoration of frothy sputum is the hallmark of severe RPE and patient needs immediate treatment.3. After adequate treatment, clinical manifestation of RPE may subside quickly, but radiological manifestation of RPE may persist for days without symptoms of RPE. 4. Drainage of pneumothorax with pigtail catheters connected to three-way stopcocks intermittently may decrease the severity of clinical manifestation of RPE , but cannot avoid the radiologic manifestation of RPE.
CLINICAL IMPLICATIONS: RPE should be kept in mind in the treatment of prolonged massive pneumothorax for early recognition and treatment. Drainage of air with pigtail catheters with three-way stopcocks instead of chest tube may decrease the severity of clinical manifestations of RPE.
DISCLOSURE: Cheng Chen, No Financial Disclosure Information; No Product/Research Disclosure Information