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Acta Radiologica

ISSN: 0284-1851 (Print) 1600-0455 (Online) Journal homepage: http://www.tandfonline.com/loi/iard20

Re‐expansion Pulmonary Edema

A. Murat, A. Arslan & A. E. Balcı

To cite this article: A. Murat, A. Arslan & A. E. Balcı (2004) Re‐expansion

Pulmonary Edema, Acta Radiologica, 45:4, 431-433
To link to this article: https://doi.org/10.1080/02841850410005624

Published online: 09 Jul 2009.

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Re-expansion Pulmonary Edema

Department of Radiology and Department of Thoracic Surgery, School of Medicine, Firat University, Elazig, Turkey

Murat A, Arslan A, Balci AE. Re-expansion pulmonary edema. Acta Radiol 2004;45:
Re-expansion pulmonary edema (REPE) is an uncommon complication following re-
expansion of the lung as treatment of conditions such as hemopneumothorax, large pleural
effusion, and after lobectomy, pneumothorax, or even during single-lung ventilation. The
majority of REPE complications are associated with treatment of spontaneous pneumothorax.
The etiology of REPE remains speculative, although it is thought to be caused by increased
pulmonary capillary permeability. Risk factors, including young age, a large pneumothorax,
and long duration of collapse, may help predict the patients that might encounter this
Key words: Pneumothorax; re-expansion pulmonary edema; REPE
Anıl Arslan, M.D., Department of Radiology, School of Medicine, Firat University, 23119
Elazig, Turkey (fax. z90 424 237 67 73, e-mail. anil_arslan@hotmail.com)
Accepted for publication 19 February 2004

Re-expansion pulmonary edema (REPE) is a rare and (9). The mechanism is obscure; some authors suggest it
potentially lethal complication of thoracostomy tube is related to surfactant depletion, others that it results
placement for pneumothorax or pleural effu-sion with from hypoxic capillary damage, leading to increased
severe atelectasis (10). Following drainage of a capillary permeability (5). The fact that REPE is
pneumothorax or a large pleural effusion, the re- concentrated mainly in the re-inflated lower lobes,
expanded lung can become acutely edematous following pleural effusion

Fig. 1. A. Chest radiograph shows completely collapsed right-side pneumothorax with REPE of the lung. B. After placement of a chest tube the chest
radiograph was normal, the right lung being fully re-expanded.

DOI 10.1080/02841850410005624 # 2004 Taylor & Francis

432 A. Murat et al.

aspiration, has led to the conclusion that hypoxic The patient’s chest radiograph showed a right-side
damage, rather than mechanical stress, is the domi-nant pneumothorax with complete collapse of the right lung
mechanism (12). Its onset can be sudden and dramatic (Fig. 1A). The patient was treated with tube
(10). Hypoxemia, hypotension, and even death have thoracostomy. After the tube was placed in position, the
been observed in case series. REPE is potentially chest radiograph was normal (Fig. 1B). Two hours later
lethal, with mortality estimates as high as 20% (3). the patient developed severe cough-ing, and became
tachycardic and tachypneic. A chest radiograph
revealed widespread alveolar consolida-tion of the
right lung as evidence of unilateral pulmonary edema
Case Report (Fig. 2A). Computed tomography (CT) of the lungs
was performed (Fig. 2B), showing increased
A 28-year-old man presented at hospital with a 1-week attenuation of the lung parenchyma, with large areas of
history of right-sided chest pain and dyspnea which ground-glass opacity (pulmonary edema) on the right
had occurred suddenly. The vital signs were normal. side. With these clinical and radiologic signs the patient
Chest examination was notable for absent breath was diagnosed as having REPE. At chest radiography
sounds over the right chest. The rest of the physical 28 h later, the pulmon-ary edema had cleared
examination was normal. completely (Fig. 2C).

Fig. 2. A. Two hours after the tube was placed, a chest radio-
graph revealed severely increased opacity of large areas of the
right lung (pulmonary edema). B. Computed tomography shows
areas of consolidation and ground-glass opacities (pulmonary
edema) of the right lung. C. Chest radiograph 28 h later shows
that the pulmonary edema has cleared completely.

Acta Radiol 2004 (4)

Re-expansion Pulmonary Edema 433

Discussion years) have been reported to be at greater risk of

developing REPE (4).
REPE occurs, uncommonly, following expansion of In conclusion, REPE most commonly occurs in the
the lung during treatment of conditions such as treatment of patients with a large pneumo-thorax of
hemopneumothorax, a large pleural effusion, or longer duration, but remains a rare complication of
pneumothorax, after lobectomy or even during single- tube thoracostomy. Some sugges-tions for preventing
lung ventilation. However, the majority of cases are or reducing such complication in high-risk patients are
associated with treatment of spontaneous supplemental oxygen, slow drainage, and avoidance of
pneumothorax (8). continuous suction (3, 4). REPE can be diagnosed and
REPE after spontaneous pneumothorax is a rare treated earlier in high-risk patients by taking repeated
complication of tube thoracostomy (4). Rapid radiographs and by careful monitoring of the clinical
reperfusion of a lung, e.g. after thrombolysis of a condition.
massive pulmonary embolus or following thrombo-
endarterectomy, may also cause acute pulmonary
edema (11). Risk factors, including young age, a large References
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Acta Radiol 2004 (4)