Reexpansion pulmonary edema

Revision as of 16:57, 16 July 2021 by Hbhbhb (talk | contribs) (→‎Risk Factors)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

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

Differential Diagnosis

Pulmonary Edema Types

Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[2]

Evaluation

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

  • 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

  1. 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.
  2. Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.