Reexpansion pulmonary edema pdf free

Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural cavity performed by either thoracentesis or. Early diagnosis is crucial, since prognosis depends on early recognition and prompt treatment. Pdf reexpansion pulmonary edema partha chakraborty. Clinical presentations include cough, chest discomfort and hypoxemia. Reexpansion pulmonary edema rpe is an important cause of unilateral pulmonary edema that rarely occurs following drainage of pleural effusion or pneumothorax. Reexpansion pulmonary edema after resection of cerebellar. It is crucial to identify risk factors young age, 3 days collapsedlung, application of negative intrapleural pressure1. 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 occurs within 24 hours of the drainage procedure and is characterized by hypoxemia and alveolar infiltrates in the reexpanded lung and even rarely in the contralateral lung.

A 32yold woman with multiple lung metastases developed severe rpe after olv during lung resection surgery. Reexpansion pulmonary edema article pdf available in indian journal of surgery 742. It is due to either failure of the left ventricle of the heart to remove blood adequately from the pulmonary circulation cardiogenic pulmonary edema, or an injury to the lung parenchyma or vasculature of the lung non. Reexpansion pulmonary edema following thoracentesis cmaj. Reexpansion pulmonary edema may be considered an iatrogenic complication due to rapid emptying of the pleural cavity.

Most patients develop symptoms within an hour of lung expansion. Dec 14, 2010 reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. Reexpansion pulmonary edema rpe is a rare complication that may occur after. Patients may present with radiographic findings alone or may have signs or. Reexpansion pulmonary edema rpe refers to pulmonary edema when the lung tissue reexpands after collapse. Reexpansion pulmonary edema free full text articles from. Scribd is the worlds largest social reading and publishing site.

The incidence referred is less than 1%, and mortality can reach up to 20%. Reexpansion pulmonary edema after therapeutic thoracentesis. 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 is an uncommon but important cause of noncardiogenic pulmonary edema. Reexpansion pulmonary edema is a rare complication with high mortality rate. Apr 08, 2011 reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. Reexpansion pulmonary edema in the left lung after insertion of a thoracostomy tube and rapid evacuation of the pneumothorax. Nov 26, 2014 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. Acute hypoxemic respiratory failure after largevolume. Reexpansion pulmonary oedema in pneumothorax bmj case.

Pulmonary reoxygenation with free radical oxygen release and neutrophiles lung infiltration is responsible of injury. Reexpansion pulmonary edema free download as powerpoint presentation. There is a broad clinical spectrum of the disease ranging from asymptomatic. Contralateral reexpansion pulmonary edema with ipsilateral collapsed lung after pleural effusion drainage. The presentation is usually rapid and dramatic and may be fatal at times.

Reexpansion pulmonary edema rpe is a rare form of noncardiogenic pulmonary edema that can result after prompt reexpansion of a chronically collapsed lung lobe. Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. Reexpansion pulmonary edema following tube thoracostomy for. 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. We present here 2 cases of reexpansion pe in which edema fluids drained from endobronchial tubes during videoassisted. This type of pulmonary edema is preventable by gradual expansion of the lung collapsed by pneumothorax.

Reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. Reexpansion pulmonary edema after therapeutic thoracentesis ncbi. Medline 1950jan 2008 using ovid interface pulmonary oedema. The left lung was collapsed due to right main stem intubation. Reexpansion pulmonary edema rpe is a rare complication of therapeutic thoracentesis. This results in pulmonary venous constriction shifting blood from the systemic to the pulmonic circulation, increase in pulmonary hydrostatic pressure and finally edema. It is due to either failure of the left ventricle of the heart to remove blood adequately from the pulmonary circulation cardiogenic pulmonary edema, or an injury to the lung parenchyma or vasculature of the lung noncardiogenic pulmonary edema.

His medical history also included alcoholic cirrhosis with portal hypertension and ascites. Images in reexpansion pulmonary oedema in pneumothorax. A 46yearold man presented to the emergency department with moderate dyspnoea and a 4day history of cough. The importance of recognizing this relatively uncommon phenomenon is stressed. Reexpansion pulmonary edema after largevolume thoracentesis. Update reexpansion pulmonary edema eduardo henrique genofre1, francisco s. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though. The oncologist rather abruptly suggests that you look up the evidence for reexpansion pulmonary oedema repo and its relationship to the volume removed. In this article, i present my views on the history, clinical features, morphophysiological features, pathogenesis, and treatment of rpe.

Reexpansion pulmonary edema rpe has been attributed to decreased lung interstitial pressures from a variety of mechanisms. Reexpansion pulmonary edema is a rare complication that may occur after drainage of pneumothorax or pleural effusion. Severe reexpansion pulmonary edema induced by onelung. Learning radiology reexpansion, reexpansion, pulmonary, edema. Olivia meira dias, lisete ribeiro teixeira, and francisco s vargas. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased pulmonary surfactant levels and a proinflammatory status are putative mechanisms. Histological abnormalities of the pulmonary microvessels in a chronically collapsed lung will cause rpe, as well as mechanical stress exerted during reexpansion. The et tube was lower on a film 4 hours prior to the first. Reexpansion pulmonary oedema repe is described in the literature, mostly after drainage of more than approximately 1 l of fluid from the pleural space. Reexpansion pulmonary edema rpe is a rare complication that may.

Teixeira3, marcelo alexandre costa vaz3, evaldo marchi3 reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. It can rarely be associated with anaesthesia and repair of traumatic. 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. Reexpansion pulmonary edema after resection of cerebellar l. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Reexpansion pulmonary edema repe is an uncommon problem that afflicts the reexpanded lung after evacuation of a large pneumothorax or pleural effusion. Unfortunately, there is no definitive treatment modality for rpe. Reexpansion pulmonary edema following tube thoracostomy for spontaneous pneumothorax in an elderly male 4. Reexpansion pulmonary edema is a rare form of acute lung injury following rapid re inflation of collapsed lung parenchyma. Two instances of unilateral pulmonary edema occurring as the result of rapid reexpansion of pneumothorax are described and illustrated.

Symptomatic reexpansion pulmonary edema occurs in less than 1% of patients after largevolume thoracentesis. Analysis of edema fluids and histologic features of the. The mechanism of reexpansion pulmonary oedema repe is unclear. If edema should occur, however, it resolves in five or six days without permanent sequelae. Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax, pleural effusion or removal of any space occupying lesion.

Pulmonary edema following the rapid reexpansion of a totally collapsed lung due to a pneumothorax. A case of pulmonary edema following reexpansion of a collapsed lung due to pneumothorax is described and illustrated. We present 2 cases of severe reexpansion pulmonary edema rpe after onelung ventilation olv for thoracic surgery. Here we report a new management modality that is very useful for a patient with rpe. Reexpansion pulmonary edema following tube thoracostomy. 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. Reexpansion pulmonary oedema in pneumothorax bmj case reports. A 37yold man with infective endocarditis also developed severe rpe after olv for mitral valve plasty with minimally invasive cardiac surgery. Unilateral pulmonary edema resulting from treatment of spontaneous pneumothorax.

Reexpansion pulmonary edema pe is a rare complication of general thoracic surgery. Reexpansion pulmonary edema the annals of thoracic surgery. Reexpansion pulmonary edema after chest drainage for pneumothorax. The high mortality rate, reported up to 21%, presses the issue for finding adequate prevention and treatment.

On the left, there is a large rightsided pneumothorax white arrows. There are multiple variables in play when evaluating the response to evacuation of pleural fluid. Reexpansion pulmonary oedema repe is described in the literature, mostly. Reexpansion pulmonary edema radiology reference article. 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 seriously affected patients, threatening their life.

On admission, a chest xray showed complete whiteout of the right hemithorax with contralateral mediastinal deviation compatible with a large pleural effusionpresumed to be. Reexpansion pulmonary edema rpe is a rare entity that develops after reexpansion in a chronically collapsed lung. Symptoms are usually noted within 24 hours after thoracentesis. Reexpansion pulmonary edema definition of reexpansion. Pulmonary edema is fluid accumulation in the tissue and air spaces of the lungs. Pdf reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Lesion pulmonar unilateral aguda secundaria a reexpansion. The role of tissue reperfusion in the reexpansion injury of the lungs.

There are many accounts of repe occurring in adults, but to my knowledge, this problem has not been reported in the pediatric population. Reexpansion pulmonary edema by talal alzahrani, nawaf. Mechanical stresses,surfactant abnormalities,neutrophil accumulation. A boy is described in whom severe unilateral pulmonary edema. Reexpansion pulmonary edema jama pediatrics jama network. Prevention of reexpansion pulmonary edema and ischemia. An hour after chest tube insertion red arrows, there is now airspace disease in the right lung yellow arrow, which has been reexpanded. The pathogenesis of rpe is probably related to histological changes of the lung parenchyma and reperfusiondamage by free radicals leading to an. 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 after chest drainage for. The onset of pulmonary edema can be delayed by up to 24 hours in some cases.

Is the mechanism of reexpansion pulmonary oedema in a. Because some recent studies have implicated mechanisms that increase microvascular permeability in rpe, we tested whether the edema were due to free radical generation during reexpansion and reoxygenation of the. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are implicated in the pathogenesis of this disorder. A number of noncardiac causes of pulmonary edema have been recognized.

We report the case of a 57 yearold female with unilateral acute lung injury secondary to pulmonary reexpansion after treatment of malignant pleural effusion. Reexpansion pulmonary edema following thoracentesis. 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 present an educational case of a critically ill patient admitted for respiratory failure who was fully dependent on ventricular pacing set at a constant rate throughout the episode of repe. A 37yold man with infective endocarditis also developed severe rpe after olv for mitral valve plasty with minimally invasive cardiac. It leads to impaired gas exchange and may cause respiratory failure. They did retract the et tube and also put in a chest tube which was not nec. Unilateral reexpansion pulmonary edema rpe is a rare complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis.

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