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