This condition is a relatively unknown complication of intercostal chest drainage and is potentially lethal in 20% of cases. Reexpansion pulmonary edema rpe is a rare complication that may occur after treatment of lung collapse caused by pneumothorax, atelectasis or pleural effusion and can be fatal in 20% of cases. South west education committee the power of 7 base hospital programs cambridge grey bruce hamilton lambton london niagara windsor. The relationship between pleural pressures and changes in pulmonary function after therapeutic thoracentesis. It results in acute onset shortness of breath that usually results within hours of reexpansion but can be delayed by 24 hours in some cases. Reexpansion pulmonary edema repe is a rare yet sometimes fatal complication associated with the treatment of lung diseases such as pleural effusion, pneumothorax, and hemothorax.
An hour after chest tube insertion red arrows, there is now airspace disease in the right lung yellow arrow, which has been reexpanded. Clinical details are given of two patients whodeveloped ipsilateral pulmonary oedema following reexpansion of their spontaneous pneumothoraces by intercostal drainage of air. Reexpansion pulmonary edema repe is a rare complication that develops after thoracostomy tube placement for treatment of pneumothorax. The pdf file you selected should load here if your web browser has a pdf reader plugin installed for example, a recent version of adobe acrobat reader. Repeated chest xray imaging revealed increased alveolar opacification of the right lung consistent with pulmonary edema. Therefore, early recognition of signs and symptoms is important since inadequate or delayed. Reexpansion pulmonary edema after treatment of simultaneous. Reexpansion pulmonary edema reexpansion pulmonary edema dubin, jeffrey s 20001101 00. Rpe was first described by pinault in 1853 as a complication of thoracentesis 1 and in 1959, carlson et al. Reexpansion pulmonary edema is an uncommon but important cause of noncardiogenic pulmonary edema. Ppt pulmonary edema powerpoint presentation free to.
Development of unilateral pulmonary edema in the reexpanded lung is a rare but recognized complication of evacuation of a pneumothorax and rapid pulmonary reexpansion. Alternatively, you can also download the pdf file directly to your computer, from where it can be opened using a. The symptoms of rxpe usually appear within the first two hours following pulmonary reexpansion. Reexpansion pulmonary edema after the insertion of a. To download the pdf, click the download link below. Reexpansion pulmonary edema rpe is a potentially lifethreatening complication that can occur after rapid lung reexpansion following the treatment of pneumothorax or pleural effusion. Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural cavity performed by either thoracentesis or. Pulmonary edema pulmonary oedema in british english is fluid in the lungs pulmonary means lungs. May 25, 2012 reexpansion pulmonary edema repe is a rare complication of treatment of spontaneous pneumothorax or large pleural effusions. Reexpansion pulmonary edema following tube thoracostomy for spontaneous pneumothorax in an elderly male 4. A tracheostomy was performed on the 7th postoperative day to provide access for frequent pulmonary toilet and bronchoscopy. Largevolume thoracentesis and the risk of reexpansion pulmonary edema. A number of factors have been identified that increase the risk of developing reexpansion pulmonary edema, and pathophysiologic mechanisms have been postulated.
Reexpansion pulmonary edema repe is an uncommon problem that afflicts the reexpanded lung after evacuation of a large pneumothorax or pleural effusion. Patients may present with radiographic findings alone or may have signs or symptoms that prompt evaluation and diagnosis. The basis for reexpansion pulmonary edema diagnosis includes the history, clinical presentation and radiological features 3. Reexpansion pulmonary edema is a noncardiogenic pulmonary edema that occurs in the setting of rapid expansion of a collapsed lung. Reexpansion pulmonary edema is a rare form of acute lung injury following rapid re inflation of collapsed lung parenchyma. Reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung.
Nov 26, 2014 we describe the case of a patient suffering from reexpansion pulmonary edema rpe after chest drainage for pneumothorax. Highflow oxygen therapy for treating reexpansion pulmonary. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of. Independent lung ventilation for reexpansion pulmonary edema. Ipsilateral reexpansion pulmonary edema after drainage of a. Unfortunately, there is no definitive treatment modality for rpe.
Reexpansion pulmonary edema, journal of emergency medicine. The pathogenesis of rpe is probably related to histological changes of the lung parenchyma and. Get a printable copy pdf file of the complete article 772k, or click on a page image below to browse page by page. Jul 17, 2017 reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung. Reexpansion pulmonary oedema rpe is a rare but potentially fatal complication with no clear cut guidelines for its management.
Nov 01, 2000 reexpansion pulmonary edema reexpansion pulmonary edema dubin, jeffrey s 20001101 00. Scribd is the worlds largest social reading and publishing site. Normally, the lungs fill with air when a person breathes in. Rpe symptoms usually appear in the first two hours after pulmonary reexpansion, and may last for 24 to 48 h, disappearing after five to seven days 3. Risk factors for the development of reexpansion pulmonary. We describe the case of a patient suffering from reexpansion pulmonary edema rpe after chest drainage for pneumothorax. Highflow oxygen therapy for treating reexpansion pulmonary edema. A free powerpoint ppt presentation displayed as a flash slide show on id. A best evidence topic in cardiac surgery was written according to a structured protocol. Unilateral reexpansion pulmonary edema rpe is a rare complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis. Clinical presentation the condition occurs in the setting of rapid expansion of a collapsed lung, with acute onset shortness of breath usually o. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition.
Acute pulmonary edema harrisons manual of medicine, 19e. Specific precipitants, resulting in cardiogenic pulmonary edema in pts with previously compensated heart failure or without previous cardiac history. Here we report a new management modality that is very useful for a patient with rpe. The importance of recognizing this relatively uncommon phenomenon is stressed. Reexpansion pulmonary edema after chest drainage for. Reexpansion pulmonary edema the journal of the american. The patient received supplemental oxygen via a nonrebreather face mask to compensate for hypoxemia. Selective or independent lung ventilation ilv is one of the therapeutic modality that can be used for the treatment of such cases. The incidence referred is less than 1%, and mortality can reach up to 20%. A case of pulmonary edema following reexpansion of a collapsed lung due to pneumothorax is described and illustrated. The clinical picture is variable and sometimes onset is immediate and dramatic, causing a rapidly worsening respiratory. Ipsilateral reexpansion pulmonary edema after drainage of.
There are many accounts of repe occurring in adults, but to my knowledge, this problem has not been reported in the pediatric population. A followup chest roentgenogram revealed clearing of the edema fig. The appearance and clinical setting suggest reexpansion pulmonary edema. Alternatively, you can also download the pdf file directly to your computer, from where it can be opened using a pdf reader. Pulmonary edema is due to the movement of excess fluid into the alveoli as a result of an alteration in one or more of starlings forces. We report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. Reexpansion pulmonary edema rpe is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of. The patient had been taking penicillin for 2 days without improvement. Reexpansion pulmonary edema repe is a lethal complication, which usually occurs after rapid reexpansion of a collapsed lung following chest tube insertion. Reexpansion pulmonary edema repe is known as a rare and fatal complication after tube thoracostomy. The high mortality rate, reported up to 21%, presses the issue for finding adequate prevention and treatment.
An analysis of and new risk factors for reexpansion. Altogether 233 papers were found using the reported search, of which represented the best evidence to answer the clinical question. Reexpansion pulmonary edema following videoassisted. Reexpansion pulmonary edema reexpansion pulmonary edema mingolla, giuseppe pietro 20090101 00. In cardiogenic pulmonary edema, a high pulmonary capillary pressure as estimated clinically from the pulmonary artery wedge pressure. As a complication of spontaneous pneumothorax treatment, only few cases are documented, and even fewer document the role of noninvasive continuous positive airway pressure mechanical ventilation for treatment of this rare entity. Reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. Reexpansion pulmonary edema following thoracentesis. The edema may progress for 2448 h and persist for 45 days. The development of such edema can be prevented by avoiding application of sudden and excessive negative pleural pressures during the evacuation of a pneumothorax or a pleural effusion. Right mid and lower zone alveolar opacity developing acutely post pleural tap with drainage of a large right pleural effusion. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased pulmonary surfactant levels and a proinflammatory status are putative mechanisms. Reexpansion pulmonary edema jama pediatrics jama network.
Meckels diverticulum causing small bowel intussusception in third trimester pregnancy. Subsequently, the patient became hypoxic, requiring supplemental oxygen via nonrebreather mask. Reexpansion pulmonary edema the annals of thoracic surgery. Rpe has been reported in humans and small animals when rapid reinflation of a chronically collapsed lung lobe via spontaneous ventilation or positivepressure. A 46yearold man presented to the emergency department with moderate dyspnoea and a 4day history of cough. Sep 29, 2007 we report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. Reexpansion pulmonary edema r eexpansion pulmonary edema rpe is an uncommon but potentially fatal complication after reexpansion of a chronically collapsed lung lobe in a dog or cat. Severe reexpansion pulmonary edema developed after bilateral tube thoracoscomy, but he was recovered after 2 days ventilator care. On admission, a chest xray showed complete whiteout of the right hemithorax with contralateral mediastinal deviation compatible with a large pleural effusionpresumed to be hepatic. Reexpansion pulmonary edema rpe is a rare form of noncardiogenic pulmonary edema that can result after prompt reexpansion of a chronically collapsed lung lobe.
His medical history also included alcoholic cirrhosis with portal hypertension and ascites. Pdf reexpansion pulmonary edema partha chakraborty. We investigated the risk factors for the development of repe in patients with spontaneous pneumothorax. When the injury to the lung is primarily one sided, conventional modes of ventilation can be ineffective and at times harmful. Despite this initial improvement the patients course was further complicated by sepsis, presumably from a pulmonary source. Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax, pleural effusion or removal of any space occupying lesion. In cardiogenic pulmonary edema, a high pulmonary capillary pressure as estimated clinically from the pulmonary artery wedge pressure is responsible for the abnormal fluid movement. Reexpansion pulmonary edema repe is a rare complication of treatment of spontaneous pneumothorax or large pleural effusions. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are implicated in. Increased permeability of pulmonary alveolarcapillary membrane noncardiogenic pulmonary edema. From the alveoli in the lungs, oxygen goes into the blood. Carlos echevarria, darragh twomey, joel dunning, binayak chanda, does reexpansion pulmonary oedema exist.
The radiographic evidence of reexpansion pulmonary edema is a unilateral alveolar filling pattern, seen within a few hours of reexpansion of the lung. Reexpansion pulmonary edema definition of reexpansion. After bilateral wedge resection and talc pleurodesis, he was discharged without complications and had remained well and without recurrence during the 8year. Pulmonary edema simple english wikipedia, the free. Reexpansion pulmonary edema rpe is a rare complication of therapeutic thoracentesis. We selected patients who were diagnosed with spontaneous pneumothorax and were initially treated with tube thoracostomy between august 1, 2003 and december 31, 2011. Reexpansion pulmonary edema rpe remains a relatively rare complication of evacuation of air or fluid from the pleural space, rapid reexpansion of substantial atelectasis, or following lung. Learning radiology reexpansion, reexpansion, pulmonary, edema. The patient was admitted to the intensive care unit and remained stable with 30 lminute highflow nasal cannula for 2 days. It can rarely be associated with anaesthesia and repair of traumatic. The role of tissue reperfusion in the reexpansion injury of the lungs. We report a case of 46yearold male with simultaneous bilateral spontaneous tension pneumothorax. Reexpansion pulmonary edema is a rare complication that may occur after drainage of pneumothorax or pleural effusion.
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