Re-expansion Pulmonary Edema as a Complication of a Spontaneous Pneumothorax Drainage – a Case Review

Czech version

Authors: T. Toporcer; J. Iľková; L. Lakyová; J. Belák; J. Radoňak
Authors‘ workplace: II. chirurgická klinika, LF, UPJŠ, Košice, Slovenská republika, prednosta: MUDr. J. Belák, Ph. D.
Published in: Rozhl. Chir., 2008, roč. 87, č. 7, s. 347-351.
Category: Monothematic special - Original

Overview

Reexpansion pulmonary edema is an iatrogenic complication occurring after reinflation of the collapsed lung of a patient with pneumothorax or fluidothorax. The following risk factors have been associated with reexpansion pulmonary edema: younger age, longer duration of a lung collapse, its large extend and a quick lung reexpansion.

We report a case of 26-years-old man. The patient was admited to the second surgical clinic FNLP, Košice because of a spontaneous pneumothorax. A chest tube was inserted in local anesthesia in the right anterior axilar line and the fourth intercostal space. An active negative pressure of 20 cm H₂O was applied. Dyspnea, decrease of blood pressure, tachycardia, tachypnoe and expectoration of pink sputum were recorded after negative pressure application. Oxygen saturation decreased to 90% despite the addition of oxygen. Glucocorticoids, diuretic stimulants, analgesic and bronchodilatators were administered. Chest X-rays and computer tomography showed a strong ipsilateral pulmonary edema and an incipient contralateral pulmonary edema. The patient was stabilized and after 16 hours continuous oxygen administration was not longer needed. Because of continuous pneumothorax, a video assisted thoracoscopic surgery was performed on the seventh day after the chest tube insertion. After 13 days of hospitalization the patient was discharged in good condition without any further complications to the ambulatory care.

Reexpansion pulmonary edema is a rare complication of the chest tube insertion and thoracocentesis because of pneumothorax and fluidothorax. The mortality of reexpansion pulmonary edema reaches up to 20%. Chest tube insertion and thoracocentesis are therapeutic procedures to be performed solely on medical department which can provide artificial lung ventilation.

Key words:
reexpansion pulmonary edema – spontaneous pneumothorax – chest tube insertion

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