Re Expansion Pulmonary Edema

Acta Radiologica
ISSN: 0284-1851 (Print) 1600-0455 (Online) Journal homepage: http://www.tandfonline.com/loi/iard20
Re‐expansion Pulmonary Edema
A. Murat, A. Arslan & A. E. Balcı
To cite this article: A. Murat, A. Arslan & A. E. Balcı (2004) Re‐expansion

Pulmonary Edema, Acta Radiologica, 45:4, 431-433
To link to this article: https://doi.org/10.1080/02841850410005624
Published online: 09 Jul 2009.
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CASE REPORT ACTA RADIOLOGICA
Re-expansion Pulmonary Edema

A. MURAT, A. ARSLAN & A. E. BALCI
Department of Radiology and Department of Thoracic Surgery, School of Medicine, Firat University, Elazig, Turkey
Murat A, Arslan A, Balci AE. Re-expansion pulmonary edema. Acta Radiol 2004;45:
431–433.
Re-expansion pulmonary edema (REPE) is an uncommon complication following re-
expansion of the lung as treatment of conditions such as hemopneumothorax, large pleural
effusion, and after lobectomy, pneumothorax, or even during single-lung ventilation. The
majority of REPE complications are associated with treatment of spontaneous pneumothorax.
The etiology of REPE remains speculative, although it is thought to be caused by increased
pulmonary capillary permeability. Risk factors, including young age, a large pneumothorax,
and long duration of collapse, may help predict the patients that might encounter this
complication.
Key words: Pneumothorax; re-expansion pulmonary edema; REPE
Anıl Arslan, M.D., Department of Radiology, School of Medicine, Firat University, 23119
Elazig, Turkey (fax. z90 424 237 67 73, e-mail. anil_arslan@hotmail.com)
Accepted for publication 19 February 2004
Re-expansion pulmonary edema (REPE) is a rare and (9). The mechanism is obscure; some authors suggest it
potentially lethal complication of thoracostomy tube is related to surfactant depletion, others that it results
placement for pneumothorax or pleural effu-sion with from hypoxic capillary damage, leading to increased
severe atelectasis (10). Following drainage of a capillary permeability (5). The fact that REPE is
pneumothorax or a large pleural effusion, the re- concentrated mainly in the re-inflated lower lobes,
expanded lung can become acutely edematous following pleural effusion
Fig. 1. A. Chest radiograph shows completely collapsed right-side pneumothorax with REPE of the lung. B. After placement of a chest tube the chest
radiograph was normal, the right lung being fully re-expanded.
DOI 10.1080/02841850410005624 # 2004 Taylor & Francis

432 A. Murat et al.
aspiration, has led to the conclusion that hypoxic The patient’s chest radiograph showed a right-side
damage, rather than mechanical stress, is the domi-nant pneumothorax with complete collapse of the right lung
mechanism (12). Its onset can be sudden and dramatic (Fig. 1A). The patient was treated with tube
(10). Hypoxemia, hypotension, and even death have thoracostomy. After the tube was placed in position, the
been observed in case series. REPE is potentially chest radiograph was normal (Fig. 1B). Two hours later
lethal, with mortality estimates as high as 20% (3). the patient developed severe cough-ing, and became
tachycardic and tachypneic. A chest radiograph
revealed widespread alveolar consolida-tion of the
right lung as evidence of unilateral pulmonary edema
Case Report (Fig. 2A). Computed tomography (CT) of the lungs
was performed (Fig. 2B), showing increased
A 28-year-old man presented at hospital with a 1-week attenuation of the lung parenchyma, with large areas of
history of right-sided chest pain and dyspnea which ground-glass opacity (pulmonary edema) on the right
had occurred suddenly. The vital signs were normal. side. With these clinical and radiologic signs the patient
Chest examination was notable for absent breath was diagnosed as having REPE. At chest radiography
sounds over the right chest. The rest of the physical 28 h later, the pulmon-ary edema had cleared
examination was normal. completely (Fig. 2C).
Fig. 2. A. Two hours after the tube was placed, a chest radio-
graph revealed severely increased opacity of large areas of the
right lung (pulmonary edema). B. Computed tomography shows
areas of consolidation and ground-glass opacities (pulmonary
edema) of the right lung. C. Chest radiograph 28 h later shows
that the pulmonary edema has cleared completely.
Acta Radiol 2004 (4)

Re-expansion Pulmonary Edema 433
Discussion years) have been reported to be at greater risk of

developing REPE (4).
REPE occurs, uncommonly, following expansion of In conclusion, REPE most commonly occurs in the
the lung during treatment of conditions such as treatment of patients with a large pneumo-thorax of
hemopneumothorax, a large pleural effusion, or longer duration, but remains a rare complication of
pneumothorax, after lobectomy or even during single- tube thoracostomy. Some sugges-tions for preventing
lung ventilation. However, the majority of cases are or reducing such complication in high-risk patients are
associated with treatment of spontaneous supplemental oxygen, slow drainage, and avoidance of
pneumothorax (8). continuous suction (3, 4). REPE can be diagnosed and
REPE after spontaneous pneumothorax is a rare treated earlier in high-risk patients by taking repeated
complication of tube thoracostomy (4). Rapid radiographs and by careful monitoring of the clinical
reperfusion of a lung, e.g. after thrombolysis of a condition.
massive pulmonary embolus or following thrombo-
endarterectomy, may also cause acute pulmonary
edema (11). Risk factors, including young age, a large References
pneumothorax, and longer duration of collapse, may
help predict the patients at risk of encountering this 1. Fujino S, Tezuka N, Inoue S, et al. Reexpansion pulmonary
edema due to high-frequency jet ventilation: report of a
complication (6). case. Surg Today 2000;30:1110–1.
The etiology of REPE remains speculative, although 2. Heller BJ, Grathwohl MK. Contralateral reexpansion
it is thought to be caused by increased pulmonary pulmonary edema. South Med J 2000;93:828–31.
capillary permeability (1). An inflam-matory response 3. Mahfood S, Hix WR, Aaron BL, Blaes P, Watson DC.
Reexpansion pulmonary edema. Ann Thorac Surg
occurring when the lung re-expands is believed to be 1988;45:340–5.
secondary to expansion-related mechanical injury to 4. Matsuura Y, Nomimura T, Murakami H, Matsushima T,
the alveolar-capillary membrane and reperfusion injury Kakehashi M, Kajihara H. Clinical analysis of reexpansion
as blood flow returns to the now fully expanded lung pulmonary edema. Chest 1991;100:1562–6.
5. Miller WC, Toon R, Palat H. Experimental pulmonary
(10). It has been reported in several case series that the edema following re-expansion pneumothorax. Am Rev
likelihood of developing REPE is directly related to Respir Dis 1973;108:664–6.
the size of the pneumothorax, the rapidity at which the 6. Scott CS. Reexpansion pulmonary edema: a case report and
pneumothorax is drained, and the duration of review of the current literature. J Emerg Med 2003;24:23–7.
symptoms before radiologic detection (3, 4). In many
7. Shaw TJ, Caterine JM. Recurrent re-expansion pul-monary
patients, rapid expansion is caused by aspiration with a edema. Chest 1984;86:784–6.
high negative pressure, although this is not always the 8. Tan HC, Mak KH, Johan A, Wang YT, Poh SC. Cardiac
case. Exceptional cases of recurrent edema are output increases prior to development of pulmonary edema
reported with treat-ment of recurrent pneumothorax after re-expansion of spontaneous pneumothorax. Respir
Med 2002;96:461–5.
(7).
9. Tarver RD, Broderick LS, Conces DJ. Reexpansion
pulmonary edema. J Thorac Imaging 1996;11:198–209.
The clinical picture of REPE can be dramatic. Onset 10. Trachiotis GD, Vricella LA, Aaron BL, Hix WR.
usually occurs immediately following lung re- Reexpansion pulmonary edema. Updated in 1997. Ann
expansion, with 64% of patients exhibiting symp-toms Thorac Surg 1997;63:1206–7.
within 1 h. All reported patients became sym-ptomatic 11. Ward BJ, Pearse DB. Reperfusion pulmonary edema after
within 24 h (3). Severe coughing often heralds the thrombolytic therapy of massif pulmonary embo-lism. Am
Rev Respir Dis 1988;138:1308–11.
development of pulmonary edema. The patient 12. Woodring JF. Focal reexpansion pulmonary edema after
becomes tachypneic and tachycardic as hypoxia drainage of large pleural effusions: clinical evidence
increases. Rarely, bilateral or contralateral edeme suggesting hypoxic injury to the lung as the cause of edema.
develops (2). Young patients (under 40 South Med J 1997;90:1176–82.
Acta Radiol 2004 (4)

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Acta Radiologica

ISSN: 0284-1851 (Print) 1600-0455 (Online) Journal homepage: http://www.tandfonline.com/loi/iard20

Re‐expansion Pulmonary Edema

A. Murat, A. Arslan & A. E. Balcı

To cite this article: A. Murat, A. Arslan & A. E. Balcı (2004) Re‐expansion

Published online: 09 Jul 2009.

Submit your article to this journal

Article views: 135

Full Terms & Conditions of access and use can be found at

Re-expansion Pulmonary Edema

DOI 10.1080/02841850410005624 # 2004 Taylor & Francis

Acta Radiol 2004 (4)

Discussion years) have been reported to be at greater risk of

Acta Radiol 2004 (4)

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