Findings are severe dyspnea, diaphoresis, wheezing, and sometimes bloodtinged frothy sputum. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical. A number of noncardiac causes of pulmonary edema have been recognized. Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural cavity performed by either thoracentesis or chest drainage. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are implicated in the pathogenesis of this disorder. The exact differentiation and diagnosis is made based on a combination of clinical and radiological findings and considerations. Although there are numerous noncardiac causes of pulmonary edema l, unilateral pulmonary edema fol lowing reexpansion of a collapsed lung is a rare compli cation 2,3. Reexpansion pulmonary edema is a rare complication of thoracocentesis with mortality rates as high as 20%. An uncommon complication of a common clinical scenario.
Another possible mechanism is that alveolar distention during reexpansion causes physical damage. Although the exact pathophysiologic mechanism for left ventricular dysfunction after pericardiocentesis re. Treatment for pulmonary edema varies depending on the cause but generally includes supplemental oxygen and medications. Pulmonary edema can sometimes be fatal, but the outlook improves if you get treated quickly. Reexpansion pulmonary oedema in pneumothorax bmj case reports. 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. Learning radiology reexpansion, reexpansion, pulmonary, edema. Decreased lung interstitial pressure caused by rapid expansion of a collapsed lung has been thought to be an essential factor for the development of rpe.
Reexpansion pulmonary edema rpe is a lifethreatening but rare complication after reexpansion of a collapsed lung. Despite being infrequent, mortality may occur in up to 20% of cases and is attributed to the abrupt reduction in pleural pressure, especially as a result of extensive. 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. Reexpansion pulmonary edema rpe is a rare complication that may occur after treatment of lung collapse caused by pneumothorax. The main hypothesis considers it to be a result of an acute inflammatory response that causes damage to the alveolarcapillary membrane, and changes in the pulmonary lymphatic vessels and in the surfactant. Similar radiologic appearances could result from a rapidly evolving pneumonitis, especially in. The onset of pulmonary edema can be delayed by up to 24 hours in some cases. An hour after chest tube insertion red arrows, there is now airspace disease in the right lung yellow arrow, which has been reexpanded.
Reexpansion pulmonary oedema is an uncommon complication occurring in less than 1% of cases where a lung has been rapidly reexpanded after being passively collapsed by a large pleural effusion or a pneumothorax. Clinical presentation the condition occurs in the setting of rapid expansion of a collapsed lung, with acute onset shortness of breath usually o. Based on the clinical and radiological findings, a diagnosis of reexpansion pulmonary oedema was made. Although the pathophysiology of reexpansion pulmonary edema is multifactorial and poorly understood, new investigations are uncovering possible mechanisms. Reexpansion pulmonary edema is a noncardiogenic pulmonary edema that occurs in the setting of rapid expansion of a collapsed lung. These patients may develop hypotension or oliguria resulting from rapid fluid shifts into the lung. Acute pulmonary edema after pericardial drainage for. Reexpansion pulmonary edema following local anesthetic. The purpose of this study was to define the incidence of rpe among patients undergoing largevolume. Google scholar see all references pulmonary edema was described as a complicating event in reexpansion of a totally collapsed lung.
Diuretics and preload reduction are contraindicated, and intravascular volume. In cardiogenic pulmonary edema, the central therapeutic focus is to decrease preload by aggressive diuresis using loop diuretics. We read with interest the editorial by mahajan, reexpansion pulmonary edema, chest 1983. A search of the literature disclosed 51 additional cases of unilat eral pulmonary edema following lung reexpansion in pneumothorax. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are implicated in the pathogenesis. One of the more promising theories suggests that the root of the condition is increased permeability of the pulmonary capillaries as a result of inflammation. The etiology is thought to be a surge of catecholamines that results in cardiopulmonary dysfunction. Rpe has been reported in humans and small animals when rapid reinflation of a chronically collapsed lung lobe via spontaneous ventilation or positivepressure. Chart 2 risk factors for the development of reexpansion pulmonary edema. Peripheral edema often poses a dilemma for the clinician be cause it. As none of the procedures were technically complicated, an association can be suggested between these 2 rare complications. To avoid reexpansion pulmonary edema rpe, thoracenteses are often limited to draining no more than 1 l. Edema occurs when an excessive volume of fluid accumulates in the tissues, either within cells cellular edema or within the collagenmucopolysaccharide. Reexpansion pulmonary edema is a rare form of acute lung injury following rapid re inflation of collapsed lung parenchyma.
We describe the case of a patient suffering from reexpansion pulmonary edema rpe after chest drainage for pneumothorax. Pulmonary edema is acute, severe left ventricular failure with pulmonary venous hypertension and alveolar flooding. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Reexpansion pulmonary oedema in pneumothorax bmj case. Prevention of reexpansion pulmonary edema and ischemia. It occurs following 1% of pneumothorax reexpansions or thoracentesis procedures. 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 repe is an uncommon complication after reinflation of a collapsed lung.
Its a consequence of the rapid expansion of a previously collapsed lung due to a pleural effusion, pneumothorax, etc. Reexpansion pulmonary edema has now been well documented. Largevolume thoracentesis and the risk of reexpansion pulmonary edema. In this article, i present my views on the history, clinical features, morphophysiological features, pathogenesis, and treatment of rpe. There is a broad clinical spectrum of the disease ranging from asymptomatic. Pulmonary edema cardiovascular disorders merck manuals. For clinical purposes, pulmonary edema is grossly divided based on pathophysiology in cardiogenic and noncardiogenic edema. The radiographic evidence of reexpansion pulmonary edema is a unilateral alveolar filling pattern, seen within a few hours of reexpansion of the lung. Symptomatic reexpansion pulmonary edema is an uncommon complication of a thoracentesis, occurring in less than 1% of procedures in recent large case series 2, 9. Reexpansion pulmonary edema rpe is a severe disorder, and its pathophysiology is not well understood.
Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural cavity performed by either thoracentesis or. It can rarely be associated with anaesthesia and repair of traumatic. It follows sudden reexpansion of one lung from any of the above named causes. Pathophysiology of reexpansion pulmonary edema the pathophysiology of reexpansion pulmonary edema is multifactorial and not yet completely understood. This results in pulmonary venous constriction shifting blood from the systemic to the pulmonic circulation, increase in pulmonary hydrostatic pressure and finally edema. 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 this can develop after removal of longstanding pleural space air or fluid. The severity in clinical presentation can be widely varied from radiographic changes only to rapidly progressive respiratory failure requiring mechanical ventilation. On the left, there is a large rightsided pneumothorax white arrows. The pathogenesis of rpe is probably related to histological changes of the lung parenchyma and reperfusiondamage by free radicals leading to an. Pdf reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Figure 1 pathophysiology of reexpansion pulmonary edema. Reexpansion pulmonary edema following thoracentesis cmaj.
Reexpansion pulmonary edema rpe is a rare complication that can occur after rapid reinflation of the lung following thoracentesis of a pleural effusion or chest tube drainage of pneumothorax. 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. Histological abnormalities of the pulmonary microvessels in a chronically collapsed lung will cause rpe, as well as mechanical stress exerted during reexpansion. Rpe is a rare complication of the treatment of lung collapse secondary to pneumothorax, pleural. One proposed mechanism for rpe is that chemical substances such as cytokines increase alveolar permeability. Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural. The risk factors for the same should be carefully assessed and considered before chest tube drainage. Reexpansion pulmonary edema after chest drainage for. Acute pulmonary edema following the treatment of spontaneous pneumothorax with excessive negative intrapleural pressure.
The pathophysiology of rxpe is complex and involves several. Reexpansion pulmonary edema stawicki sp, sarani b, braslow bm. Pulmonary edema that develops suddenly acute pulmonary edema is a medical emergency requiring immediate care. Reexpansion pulmonary edema definition of reexpansion. It presents with tachycardia, hypotension, and hypoxemia within hours after thoracocentesis. The exact pathophysiology of reexpansion pulmonary edema is unclear, and many of the studies exploring potential mechanisms are now several decades old. Indications the indication for large volume thoracentesis is dyspnea due to a moderate to large pleural effusion confirmed by physical examination and chest radiography.
The condition occurs in the setting of rapid expansion of a collapsed lung, with acute onset shortness of breath usually occurring within hours of reexpansion. The onset of symptoms is usually within 24 hours, with 64% of patients having onset within 12 hours after lung reexpansion. There are, however, significant clinical benefits to removing more than 1 l of fluid. Risk factors for the development of reexpansion pulmonary. Reexpansion pulmonary edema rpe and ischemiareperfusion ir injury are now recognized as potentially fatal complications of. Reexpansion pulmonary edema repe is known as a rare and fatal complication after tube thoracostomy. The total volume drained was calculated to be 55 l. 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. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of.
May 05, 2018 reexpansion pulmonary edema is a rare but relevant consideration after a large volume thoracentesis. The role of tissue reperfusion in the reexpansion injury of the lungs. Apr 08, 2011 reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. Pdf reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical. Reexpansion pulmonary edema following thoracentesis. Reexpansion pulmonary edema after therapeutic thoracentesis ncbi. Apr 24, 2019 fellerkopman d, berkowitz d, boiselle p, ernst a. The precise pathophysiologic abnormalities associated with. In cardiogenic pulmonary edema, a high pulmonary capillary pressure as estimated clinically from the pulmonary artery wedge pressure is.
Reexpansion pulmonary edema is an uncommon complication following rapid reexpansion of the lungs. The pathophysiology of repe is not clearly understood. In the 1980s, rpe was thought to originate from an increased permeability of damaged pulmonary blood vessels, caused by a. Unilateral reexpansion pulmonary edema rpe is a rare complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis. The patient recovered completely after 2 days of supportive treatment and a further chest xray showed clear lung fields bilaterally. Severe reexpansion pulmonary edema induced by onelung. 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 resection. At this time, it seems that the pathophysiology of reexpansion pulmonary edema is probably multifactorial, but abnormal pulmonary capillary permeability seems. Reexpansion pulmonary edema is an uncommon but important cause of noncardiogenic pulmonary edema. Reexpansion pulmonary edema after resection of cerebellar. Reexpansion pulmonary edema repe is a rare but potentially lethal complication that can arise in the reexpanding lung following drainage of pleural effusions or pneumothoraces.
This condition is a relatively unknown complication of intercostal chest drainage and is potentially lethal in 20% of cases 1. Reexpansion pulmonary edema after therapeutic thoracentesis. The precise pathophysiology underlying reexpansion pulmonary oedema has not. The pathogenesis of rpe is probably related to histological changes of the lung parenchyma and. In most cases, the atelectasis is total and has been present for three or. Acute hypoxemic respiratory failure after largevolume. Reexpansion pulmonary edema repe is a rare but potentially lifethreatening complication resulting from rapid reexpansion of the collapsed lung after drainage of pleural effusion, pneumothorax, or atelectasis with a mortality rate of around 20%. One is a histological abnormality of the pulmonary microvessels caused by chronic lung collapse, and the other. Thus, it is unusual to find pulmonary edema when hypoalbuminemia is the only abnormality.
Oct 16, 2017 neurogenic pulmonary edema npe is a clinical syndrome characterized by the acute onset of pulmonary edema following a significant insult to the cns. The purpose of this study was to define the incidence of rpe among patients undergoing large. It is most commonly described with lung reexpansion after treatment of pneumothorax or pleural effusion, although other etiologies eg, mediastinal tumor resection1 have also been reported. We investigated the risk factors for the development of repe in patients with spontaneous pneumothorax. Development of unilateral pulmonary edema in the reexpanded lung is a rare but recognized complication of evacuation of a pneumothorax and rapid pulmonary reexpansion. Reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. 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. We agree that awareness of this complication can help prevent its occurrence. The precise pathophysiology underlying reexpansion pulmonary oedema has. Although there are numerous noncardiac causes of pulmonary edema l, unilateral pulmonary edema fol lowing reexpansion of a collapsed lung is a rare.
Reexpansion pulmonary edema the annals of thoracic surgery. Hepatic hydrothorax transudative pleural effusions. Reexpansion pulmonary edema after drainage of pneumothorax. The edema may progress for 2448 h and persist for 45 days. The relationship between pleural pressures and changes in pulmonary function after therapeutic thoracentesis. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased. Largevolume thoracentesis and the risk of reexpansion. 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. Each developed reexpansion pulmonary edema during their first thoracentesis, followed by a pneumothorax during their second thoracentesis. The onset of rpe is acute, and the patients might experience a sharp declination in oxygen saturation, hypotension and shock might be seen in some. This phenomenon was first described by pinault in the mid19th century but its incidence following pleural intervention remains unknown, even 150 years later. Reexpansion pulmonary edema rpe refers to pulmonary edema when the lung tissue reexpands after collapse. Reexpansion pulmonary edema rpe is a rare entity that develops after reexpansion in a chronically collapsed lung.