Reexpansion pulmonary edema: Difference between revisions
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*Incidence may be as low as 1% or as high as 14%<ref>Mukhopadhyay A, Mitra M, Chakrabati S. Reexpansion pulmonary edema following thoracentesis. J Assoc Chest Physicians [serial online] 2016 [cited 2018 Oct 11];4:30-2. Available from: http://www.jacpjournal.org/text.asp?2016/4/1/30/159871.</ref> | *Incidence may be as low as 1% or as high as 14%<ref>Mukhopadhyay A, Mitra M, Chakrabati S. Reexpansion pulmonary edema following thoracentesis. J Assoc Chest Physicians [serial online] 2016 [cited 2018 Oct 11];4:30-2. Available from: http://www.jacpjournal.org/text.asp?2016/4/1/30/159871.</ref> | ||
===Risk Factors=== | |||
Poorly understood, but may include: | |||
*PTX > 30% in size | |||
*PTX symptoms for prolonged time, >3 days | |||
*Type 2 DM | |||
===Prevention=== | |||
*Consider using smaller bore chest tubes | |||
* | |||
*Other strategies include applying water seal only or attaching only a Heimlich valve without suction | *Other strategies include applying water seal only or attaching only a Heimlich valve without suction | ||
==Clinical Features== | ==Clinical Features== | ||
* | *Unilateral pulmonary edema presenting within minutes to hours after thoracentesis or other rapid thoracic decompression | ||
**Patients will generally present with acute onset dyspnea, cough, hypoxemia, tachycardia | |||
***Potentially fatal complication | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Pulmonary edema types}} | |||
==Evaluation== | ==Evaluation== | ||
[[File:PMC2827779 kjr-11-164-g003.png|thumb|Bilateral re-expansion pulmonary edema seven hours after thoracentesis for right pneumothorax. Reveals mixed ground-glass opacity and minimal consolidation combined with intralobular reticulations and interlobular septal thickening; Note tip of chest tube (arrowhead).]] | |||
*Radiographic opacities in previously collapsed lung | |||
==Management== | ==Management== | ||
*Supportive, as is with other forms of noncardiogenic pulmonary edema | |||
**If a patient requires intubation, positive pressure ventilation improves symptoms after 24-48 hours | |||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Chest tube]] | |||
*[[Pneumothorax]] | |||
*[[Needle thoracostomy]] | |||
==External Links== | ==External Links== | ||
| Line 37: | Line 41: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pulmonary]] | |||
Latest revision as of 16:57, 16 July 2021
Background
- Incidence may be as low as 1% or as high as 14%[1]
Risk Factors
Poorly understood, but may include:
- PTX > 30% in size
- PTX symptoms for prolonged time, >3 days
- Type 2 DM
Prevention
- Consider using smaller bore chest tubes
- Other strategies include applying water seal only or attaching only a Heimlich valve without suction
Clinical Features
- Unilateral pulmonary edema presenting within minutes to hours after thoracentesis or other rapid thoracic decompression
- Patients will generally present with acute onset dyspnea, cough, hypoxemia, tachycardia
- Potentially fatal complication
- Patients will generally present with acute onset dyspnea, cough, hypoxemia, tachycardia
Differential Diagnosis
Pulmonary Edema Types
Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[2]
- Cardiogenic pulmonary edema
- Noncardiogenic pulmonary edema
- Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion pulmonary edema
- Strangulation
- Neurogenic causes
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Inhalation injury
- Pulmonary contusion
- Aspiration pneumonia and pneumonitis
- Other
- High altitude pulmonary edema
- Hypertensive emergency
- ARDS
- Flash pulmonary edema
- Immersion pulmonary edema
- Hantavirus pulmonary syndrome
- Missed dialysis in kidney failure
- Naloxone reversal
- Negative pressure pulmonary edema
Evaluation
- Radiographic opacities in previously collapsed lung
Management
- Supportive, as is with other forms of noncardiogenic pulmonary edema
- If a patient requires intubation, positive pressure ventilation improves symptoms after 24-48 hours
Disposition
See Also
External Links
References
- ↑ Mukhopadhyay A, Mitra M, Chakrabati S. Reexpansion pulmonary edema following thoracentesis. J Assoc Chest Physicians [serial online] 2016 [cited 2018 Oct 11];4:30-2. Available from: http://www.jacpjournal.org/text.asp?2016/4/1/30/159871.
- ↑ Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.