Repe is potentially lethal with mortality estimates as high as 20%. The incidence referred is less than 1%, and mortality can reach up to 20%. Proanthocyanidin to prevent formation of the reexpansion. Reexpansion pulmonary edema is a potentially lifethreatening complication of lung reexpansion after thoracentesis or tube thoracostomy. Reexpansion pulmonary edema can be a complication of thoracentesis.
Because some recent studies have implicated mechanisms that increase microvascular permeability in rpe, we tested whether the edema were due to free radical generation during reexpansion and reoxygenation of the collapsed lung. Early recognition and a fast symptom orientated therapy are necessary for a good outcome. After the insertion of a chest tube he developed a. Reexpansion pulmonary edema, acute lung injury, risk factors, lung reinflation, diagnosis and treatment, morbidity and mortality. We report a case of 46yearold male with simultaneous bilateral spontaneous tension pneumothorax. Update reexpansion pulmonary edema eduardo henrique genofre1, francisco s. Reexpansion pulmonary edema repe is a rare but potentially lethal complication that can arise in the reexpanding lung following drainage of pleural effusions or pneumothoraces. It can occur in every type of chronically collapsed lung, including pneumothorax, pleural effusion, or a huge mediastinal mass.
Reexpansion pulmonary edema opus 12 foundation, inc. From the alveoli in the lungs, oxygen goes into the blood. Reexpansion pulmonary edema after largevolume thoracentesis. Severe reexpansion pulmonary edema developed after bilateral tube thoracoscomy, but he was recovered after 2 days ventilator care. A 52year yearold female presented with a chief complaint of 5 days dyspnea, four pillow. The edema may progress for 2448 h and persist for 45 days. On the left, there is a large rightsided pneumothorax white arrows.
A 46yearold man presented to the emergency department with moderate dyspnoea and a 4day history of cough. The pathogenesis of rpe is probably related to histological changes of the lung parenchyma and reperfusiondamage by free radicals leading to an increased vascular permeability. Reexpansion pulmonary edema stawicki sp, sarani b, braslow bm. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased pulmonary surfactant levels and a proinflammatory status are putative mechanisms. Although most patients completely recover within five to seven days, severe reexpansion pulmonary edema can lead to sequestration of large quantities of fluid in the lung, which may result in shock and possibly death. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical. We investigated the risk factors for the development of repe in patients with spontaneous pneumothorax. Reexpansion pulmonary edema following thoracentesis article pdf available in canadian medical association journal 18218. Reexpansion pulmonary edema is an uncommon complication of the treatment of lung atelectasis, pleural effusion or pneumothorax. Reexpansion pulmonary edema is a rare complication that may occur after drainage of pneumothorax or pleural effusion. Largevolume thoracentesis and the risk of reexpansion. Rpe has been reported in humans and small animals when rapid reinflation of a chronically collapsed lung lobe via spontaneous ventilation or positivepressure. Reexpansion pulmonary oedema repo constitutes a non rare complication with many not yet elucidating causative factors.
Included in this category are patients with large pleural. It usually follows rapid reinflation of collapsed lung parenchyma, with an incidence up to 1% following evacuation of. Reexpansion pulmonary edema rpe is a rare complication that can. Hospital medicine 2012, april 14, san diego, calif. On the other hand, there are also reports of pulmo. Mechanical stresses,surfactant abnormalities,neutrophil accumulation, ventilatorinduced injury,and ischemiareperfusion injury may all.
Atypical pulmonary edema is defined as lung edema with an unusual radiologic appearance but with clinical findings that are usually associated with wellknown causes of pulmonary edema. Reexpansion pulmonary edema may be considered an iatrogenic complication due to rapid emptying of the pleural cavity. Prevention of reexpansion pulmonary edema and ischemia. Reexpansion pulmonary edema repe is a rare and potentially lethal complication of thoracostomy tube placement for pneumothorax, pleural effusion and severe atelectasis. We present 2 cases of severe reexpansion pulmonary edema rpe after onelung ventilation olv for thoracic surgery. Severe reexpansion pulmonary edema induced by onelung. Reexpansion pulmonary edema is a rare form of acute lung injury following rapid re inflation of collapsed lung parenchyma. Positive pressure airway support decreases the need for intubation and may decrease mortality in patients with pulmonary edema. Reexpansion pulmonary edema by talal alzahrani, nawaf. Reexpansion pulmonary edema r eexpansion pulmonary edema rpe is an uncommon but potentially fatal complication after reexpansion of a chronically collapsed lung lobe in a dog or cat. Patients may present with radiographic findings alone or may have signs or symptoms that prompt evaluation and diagnosis. The radiographic evidence of reexpansion pulmonary edema is a unilateral alveolar filling pattern, seen within a few hours of reexpansion of the lung.
An hour after chest tube insertion red arrows, there is now airspace disease in the right lung yellow arrow, which has been reexpanded. Reexpansion pulmonary edema is a rare but potentially lifethreatening condition that usually occurs through rapid reexpansion of a chronically collapsed lung. Management of pulmonary edema 2014 linkedin slideshare. In fact, the average incidence of this syndrome should be much higher than 1% mentioned in your article. Scientific exhibit clinical and radiologic features of. His medical history also included alcoholic cirrhosis with portal hypertension and ascites.
Pulmonary edema simple english wikipedia, the free. Pulmonary edema pulmonary oedema in british english is fluid in the lungs pulmonary means lungs. After bilateral wedge resection and talc pleurodesis, he was discharged without complications and had remained well and without recurrence during the 8year. Pulmonary edema in these patients was categorized according to the classification scheme described earlier. Reexpansion pulmonary oedema repo constitutes a non rare complication with many not yet elucidating. The pathogenesis of rpe is probably related to histological changes of the lung parenchyma and reperfusiondamage by free radicals leading to an. The reexpansion pulmonary edema is a rare, but life threatening complication of a pneumothorax. Reexpansion pulmonary edema radiology reference article. Shortly afterwards he developed reexpansion pulmonary edema and. A case of pulmonary edema following reexpansion of a collapsed lung due to pneumothorax is described and illustrated. A number of factors have been identified that increase the risk of developing reexpansion pulmonary edema, and pathophysiologic mechanisms have been postulated. It occurs following 1% of pneumothorax reexpansions or thoracentesis procedures.
The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased pulmonary. Reexpansion pulmonary edema is an uncommon but important cause of noncardiogenic pulmonary edema. Risk factors for this condition include a young age, a long duration of lung. Unfortunately, there is no definitive treatment modality for rpe. Reexpansion pulmonary edema is a rare but relevant consideration after a large volume thoracentesis. The importance of recognizing this relatively uncommon phenomenon is stressed. The onset of pulmonary edema can be delayed by up to 24 hours in some cases. Reexpansion pulmonary edema rpe is a rare complication of therapeutic thoracentesis. Reexpansion pulmonary edema following thoracentesis. The nature of the capillary damage is not clear, but may be related to sudden stretching of the capillary bed. Reexpansion pulmonary edema in a patient with hepatic hydrothorax and minimal ascites. Reexpansion pulmonary oedema is an uncommon complication occurring in less than 1% of cases where a lung has been rapidly reexpanded after being passively collapsed by a large pleural effusion or a pneumothorax. Pdf reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical.
Reexpansion pulmonary edema after chest drainage for. We selected patients who were diagnosed with spontaneous pneumothorax and were initially treated with tube thoracostomy between august 1, 2003 and december 31, 2011. Reexpansion pulmonary edema following tube thoracostomy for spontaneous pneumothorax in an elderly male 4. It is usually selflimiting but some patients may require supportive treatment. Reexpansion pulmonary edema definition of reexpansion. Pulmonary edema is due to the movement of excess fluid into the alveoli as a result of an alteration in one or more of starlings forces. A 37yold man with infective endocarditis also developed severe rpe after olv for mitral valve plasty with minimally invasive cardiac surgery.
Medline 1950jan 2008 using ovid interface pulmonary oedema. Pdf reexpansion pulmonary edema following thoracentesis. A number of noncardiac causes of pulmonary edema have been recognized. Reexpansion pulmonary edema rpe has been attributed to decreased lung interstitial pressures from a variety of mechanisms. There is unilateral left lung reexpansion pulmonary edema. The development of such edema can be prevented by avoiding application of sudden and excessive negative pleural pressures during the evacuation of a pneumothorax or a pleural effusion. The present case describes a 57yearold korean man who developed contralateral reexpansion. Teixeira3, marcelo alexandre costa vaz3, evaldo marchi3 reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of. The potentially lethal complication of rpe is unilateral lung injury, which is initiated by cytotoxic oxygen metabolites and associated with a temporarily influx of. Contralateral reexpansion pulmonary edema with ipsilateral.
Reexpansion pulmonary edema in a patient with hepatic. Pdf reexpansion pulmonary edema a case report researchgate. Pdf a middle aged male presented to us with right side pneumothorax. Here we report a new management modality that is very useful for a patient with rpe. Contralateral reexpansion pulmonary edema with ipsilateral collapsed lung after pleural effusion drainage. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Is the mechanism of reexpansion pulmonary oedema in a heart. Reexpansion pulmonary edema repe is known as a rare and fatal complication after tube thoracostomy.
Pdf reexpansion pulmonary edema partha chakraborty. Introduction reexpansion pulmonary edema rxpe is a rare form of acute lung injury. We describe a patient who presented with a posttraumatic right pneumothorax. One author estimated it occurred once every 2 years at his institution. Reexpansion pulmonary edema following a posttraumatic. Reexpansion pulmonary edema following local anesthetic. At this time, it seems that the pathophysiology of reexpansion pulmonary edema is probably multifactorial, but abnormal pulmonary capillary permeability seems to play an important role. Several cases after non traumatic pneumothoraces are reported. This phenomenon was first described by pinault in the mid19th century but its incidence following pleural intervention remains unknown, even 150 years later. The role of tissue reperfusion in the reexpansion injury of the lungs.
Pulmonary reexpansion edema may be considered an iatrogenic complication due to rapid emptying of the pleural cavity. In cardiogenic pulmonary edema, a high pulmonary capillary pressure as estimated clinically from the pulmonary artery wedge pressure. It can rarely be associated with anaesthesia and repair of traumatic. A 32yold woman with multiple lung metastases developed severe rpe after olv during lung resection surgery. On admission, a chest xray showed complete whiteout of the right hemithorax with contralateral mediastinal deviation compatible with a large pleural effusionpresumed to be hepatic. The oncologist rather abruptly suggests that you look up the evidence for reexpansion pulmonary oedema repo and its relationship to the volume removed. The pathophysiology is complex and poorly understood. Reexpansion pulmonary edema free download as powerpoint presentation. The precise pathophysiology underlying reexpansion pulmonary oedema has not been clearly established, but.
The high mortality rate, reported up to 21%, presses the issue for finding adequate prevention and treatment. The condition occurs in the setting of rapid expansion of a collapsed lung, with acute onset shortness of breath usually occurring within hours of reexpansion. Reexpansion pulmonary oedema in pneumothorax bmj case. Reexpansion pulmonary edema rpe is a rare and acute rare complication, occurring after rapid reinflation of a collapsed lung, generally encountered after evacuation of large amount of air or fluid from the pleural space. Pdf reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Risk factors for the development of reexpansion pulmonary. Its a consequence of the rapid expansion of a previously collapsed lung due to a pleural effusion, pneumothorax, etc. It is vital that emergency physicians performing chest tube placement understand the pathophysiology of repe and its treatment. Reexpansion pulmonary edema after therapeutic thoracentesis.