SESSION TITLE: Surgery Case Report Posters I
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM
INTRODUCTION: Reexpansion Pulmonary Edema is a rare complication with high mortality rate; it usually occurs after rapid re-expansion of large pneumothorax drainage. It is crucial to identify risk factors (young age, >3 days collapsed-lung, application of negative intrapleural pressure)1. Once PRE is diagnosed immediate therapy is required.
CASE PRESENTATION: A 39-year-old male was referred to our hospital for a right pneumothorax. During the last month he presented with cough, shortness of breath and pleuritic chest pain. A thoracostomy tube was placed and partial pulmonary expansion was confirmed in a chest X-ray (figure 1). Five hours after the procedure patient started with frothy sputum, hypoxemia and gradually worsening dyspnea. A chest computed tomography showed patchy areas of consolidation, ground glass opacity in right lung and extensive pneumomediastinum (figure 2). High flow oxygen supply, intravenous diuretics and morphine were administered and continuos cardiopulmonary monitoring was established. Clinical improvement was evident during the next 2 days; total lung expansion and areas of consolidation disappeared in successive chest X-ray. However, persistent air leakage lasted for 7 days. Via right posterolateral thoracotomy a 3 centimeter bullae in the middle lobe was resected with a stapler and pleurodesis was performed. Patient was discharged 48 hours prior surgery.
DISCUSSION: RPE appears to be caused by multiple mechanisms. Increased capillary permeability due to hypoxic injury, re-perfusion injury with release of toxic oxygen free radicals and surfactant depletion, are all thought to play a major role2. Clinical features are variable and may range from asymptomatic patients to pinkish sputum, severe dyspnea, pleuritic chest pain and adult respiratory distress syndrome. Chest X-ray findings are non specific and variable, although typically unilateral airspace opacities appears 1 - 2 days and resolve within a week3. Treatment is supportive, mainly consisting of supplemental oxygen and, if necessary, mechanical ventilation. The disease is usually self-limited.
CONCLUSIONS: RPE is a rare but potencially lethal complication to consider after rapid re-expansion of large pneumothorax drainage. The mechanisms by which re-expansion pulmonary edema can occur are complex and controversial. In this case report the clinical features suggest a large period (one month approximately) of collapsed-lung before it was drained.
Reference #1: Komatsu T., Shibata S., Ryutaro Seo R; Unilateral re-expansion pulmonary edema following treatment of pneumothorax with exceptionally massive sputum production, followed by circulatory collapse; Can Respir J. 2010 Mar-Apr; 17(2): 53-55.
Reference #2: Sohara Y. Reexpansion pulmonary edema. Ann Thorac Cardiovasc Surg. 2008 Aug;14(4):205-9.
Reference #3: Baik JH, Ahn MI, Park YH, Park SH., High-Resolution CT Findings of Re-Expansion Pulmonary Edema Korean J Radiol. 2010 Mar-Apr;11(2):164-8.
DISCLOSURE: The following authors have nothing to disclose: Sebastian Peñafiel, Eugenia Libreros Niño, José González García
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