Scenario: 39 year old male developed 10% right sided pneumothorax with no major clinical signs after subclavian central line placement. Conservative observation with application of NR-mask didn't resolve the pneumothorax but actually now size has increased to 30%. You inserted chest tube with resolution of pneumothorax and proper chest tube placement as documented by immediate CXR at bedside. 10 minutes later patient went into shortness of breath. On clinical exam, bilateral breath sounds are audible but with rales more pronounced on right side. While waiting for repeat CXR, your probable diagnosis?
Answer: Re-expansion pulmonary edema (REPE)
REPE is a rare complication occurring after the insertion of a chest tube for pneumothorax or pleural effusion. REPE can occur on the ipsi- or contralateral side, can be bilateral and can even be asymptomatic.
The exact pathophysiology for this complication is unknown. Oxygen radicals are produced during the hypoxemia in the collapsed lung. Moreover, the activity of different cytokines have been implicated in the pathogenesis of REPE.
Major risk factors associated with REPE:
- younger age ( less than40 years),
- longer duration of lung collapse ( more than4 days),
- large pneumothorax ( more than 30% of a single lung)
Reference: click to get article
1. Ipsilateral reexpansion pulmonary edema after drainage of a spontaneous pneumothorax: a case report - J Med Case Reports. 2007; 1: 107. Published online 2007 September 29
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