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A Common Procedure Resulting in an Uncommon Complication: Re-Expansion Pulmonary Edema After Closed Thoracostomy for Spontaneous Pneumothorax

  • Jung Hoon Lee
    Affiliations
    Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea
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  • So Eun Kim
    Correspondence
    Reprint Address: So Eun Kim, MD, Department of Emergency Medicine, Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, Republic of Korea
    Affiliations
    Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea
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      Closed thoracostomy is a procedure commonly performed by emergency physicians throughout their working duties. Re-expansion pulmonary edema (REPE) is a relatively rare complication that occurs in < 1% of chest-tube drainages or thoracocenteses, with mortality rates as high as 20%. REPE can occur when the lung has been rapidly re-expanded after passive collapse by large pleural effusion, atelectasis, or pneumothorax (
      • Kim YK
      • Kim H
      • Lee CC
      • et al.
      New classification and clinical characteristics of reexpansion pulmonary edema after treatment of spontaneous pneumothorax.
      ). The precise pathophysiology of REPE has not been fully elucidated, but alterations in pulmonary microvasculature permeability and mechanical stress placed on the rapidly re-expanding lung are thought to be involved. Risk factors for complications include pulmonary collapse for a longer duration (> 4 days), younger age (younger than 40 years), large pneumothorax or pleural effusion (> 30% of lung volume), and rapid inflation of the lung over a short period (
      • Sherman SC.
      Reexpansion pulmonary edema: a case report and review of the current literature.
      ). Many authors advise draining not more than 1 L of fluid or air at once, and using an underwater-seal drainage apparatus rather than negative suction (
      • Terndrup TE
      • Bosco SF
      • McLean ER.
      Spontaneous pneumothorax complicating pregnancy case report and review of the literature.
      ). REPE is often self-limiting and treatment is generally conservative and supportive, but REPE can be fatal. In this short report, we describe a case of serious REPE after closed thoracostomy for spontaneous pneumothorax.
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