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Vol. 57. Issue 7.
Pages 492 (July 2021)
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Vol. 57. Issue 7.
Pages 492 (July 2021)
Clinical Image
DOI: 10.1016/j.arbr.2021.05.008
Open Access
Reexpansion Pulmonary Edema: Myth or Reality?
Edema de reexpansión pulmonar ¿mito o realidad?
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Fernando Cózar Bernala,
Corresponding author
fcozarbernal@gmail.com

Corresponding author.
, Luis Gerardo Zúñiga Sáncheza, Irene Barrero Garcíab
a Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Servicio de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Our patient was a 28-year-old man, who, after a 5-day history of pleuritic pain, was diagnosed with complete right pneumothorax on chest CT. After insertion of a 10F pleural drainage tube connected to −20cm H2O suction the patient developed irritative cough, central chest pain, hypotension, tachycardia, and desaturation. He was stabilized in the ICU, and a repeat CT scan was requested, showing ground glass opacities in the right lung, consistent with reexpansion pulmonary edema (Fig. 1). The patient did not improve and required invasive mechanical ventilation. Extubation was achieved after 48h. Apical bullous lesions and multiple blebs were observed during surgery for bullectomy and mechanical pleurodesis by video-assisted thoracoscopy. The pleural drainage tube was removed and the patient was discharged 72h after surgery, without complications.

Fig. 1.

(A and B) CT showing complete pneumothorax and unilateral ground glass pattern. (C and D) Intraoperative findings: blebs.

(0.17MB).

Reexpansion pulmonary edema, first described in 1853 by Pinault, is a rare complication, usually less than 1%, that occurs after rapid reinflation of the lung following evacuation of a pneumothorax or pleural effusion. Mortality can be as high as 20%.1 Diagnosis is clinical, supported by imaging tests. Treatment is based on supportive measures, requiring CPAP or even IMV with PEEP in the most severe cases, as occurred in our patient. Clinical suspicion is fundamental to guiding diligent action.2

References
[1]
M. Verhagen, J. van Buijtenen, J.R.L. Geeraedts.
Reexpansion pulmonary edema after chest drainage for pneumothorax: a case report and literature overview.
Respir Med Case Rep, 14 (2015), pp. 10-12
[2]
S.K. Lee, J.J. Hwang, M.H. Lim, J.H. Son, D.H. Kim.
Is severe re-expansion pulmonary edema still a lethal complication of closed thoracostomy or thoracic surgery?.
Ann Transl Med, 7 (2019), pp. 98

Please cite this article as: Cózar Bernal F, Zúñiga Sánchez LG, Barrero García I. Edema de reexpansión pulmonar ¿mito o realidad? Arch Bronconeumol. 2021;57:492.

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