Reexpansion pulmonary edema
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.