Reexpansion pulmonary edema is an uncommon but important cause of noncardiogenic pulmonary edema. Pulmonary edema cardiovascular disorders msd manual. Reexpansion pulmonary edema in a boy with spontaneous. Fro m th e d ivisio n o f a llerg y, p u lm o n ary an d c ritical c are m ed icin e, d ep artm en t o f m ed icin e, v an d erb ilt u n iversity s ch o o l o f m ed icin e, n ash ville l. Links to pubmed are also available for selected references. Medical treatment for pulmonary edema is considered an emergency if possible, find and treat the underlying cause of pulmonary edema identification and correction of precipitating factors and underlying conditions are.
Pulmonary edema india pdf ppt case reports symptoms. Reexpansion pulmonary oedema rpe is a rare but potentially fatal complication with no clear cut guidelines for its management. Reexpansion pulmonary edema is an unusual, but commonly fatal, clinical state. It leads to impaired gas exchange and may cause respiratory failure. Reexpansion pulmonary edema repe is an uncommon problem that afflicts the reexpanded lung after evacuation of a large pneumothorax or pleural effusion. The patient recovered completely after 2 days of supportive treatment and a further chest xray showed clear lung fields bilaterally. The patient received supplemental oxygen via a nonrebreather face mask to compensate for hypoxemia. Jul 17, 2017 reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung. Histological abnormalities of the pulmonary microvessels in a chronically collapsed lung will cause rpe, as well as mechanical stress exerted during reexpansion. Other causes include pulmonary embolus, anaemia and renal artery stenosis. What links here related changes upload file special pages permanent link page information wikidata. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are implicated in the pathogenesis of this disorder. Acute pulmonary edema, congestive heart failure and cardiogenic shock are a spectrum of diseases and should be considered and managed differently.
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. Preventive strategy for reexpansion pulmonary edema after. Based on the clinical and radiological findings, a diagnosis of reexpansion pulmonary oedema was made. Learning radiology reexpansion, reexpansion, pulmonary, edema. From the alveoli in the lungs, oxygen goes into the blood. We report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. The majority of patients with rpe associated with pneumothorax have been adults. Reexpansion pulmonary edema is a noncardiogenic pulmonary edema that occurs in the setting of rapid expansion of a collapsed lung. Reexpansion pulmonary edema rpe is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of lung collapse. Noncardiogenic pulmonary edema is a topic covered in the 5minute emergency consult to view the entire topic, please sign in or purchase a subscription emergency central is a collection of disease, drug, and test information including 5minute emergency medicine consult, daviss drug, mcgrawhill medicals diagnosaurus, pocket guide to diagnostic tests, and medline journals created. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased. The patient was admitted to the intensive care unit and remained stable with 30 lminute highflow nasal cannula for 2 days before the chest tube was removed.
Effectiveness of ultrasound in acute pulmonary edema diagnosis in. The radiological evidence is the pulmonary edema with interstitial opacity, consolidations, air bronchogram and evidence of lung clefts 2,8 and of kerleys b lines 25. An hour after chest tube insertion red arrows, there is now airspace disease in the right lung yellow arrow, which has been reexpanded. Prevention of reexpansion pulmonary edema and ischemia. In most of the cases, heart problems are caused due to pulmonary edema.
Reexpansion pulmonary edema radiology reference article. It is hypothesized that the regurgitation jet is directed to. 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. Dec 21, 2017 cardiogenic pulmonary edema cpe is defined as pulmonary edema due to increased capillary hydrostatic pressure secondary to elevated pulmonary venous pressure. Accumulation of blood in the pulmonary vasculature as a result of the inability of the left ventricle to pump blood forward adequately.
Jul 29, 2011 management the immediate objective of treatment is to improve oxygenation and reduce pulmonary congestion. Mechanical stresses,surfactant abnormalities,neutrophil accumulation, ventilatorinduced injury,and ischemiareperfusion injury may all contribute. 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. Unilateral pulmonary edema represents only 2% of cardiogenic pulmonary edema with predilection for the right upper lobe and is strongly associated with severe mitral regurgitation 1, 2. In cardiogenic pulmonary edema, the central therapeutic focus is to decrease preload by aggressive diuresis using loop diuretics. Independent lung ventilation for reexpansion pulmonary. Reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung. Reexpansion pulmonary edema by talal alzahrani, nawaf. Similar radiologic appearances could result from a rapidly evolving pneumonitis, especially in. Clinical presentation the condition occurs in the setting of rapid expansion of a collapsed lung, with acute onset shortness of breath usually o.
Acute unilateral reexpansion pulmonary edema after. The importance of recognizing this relatively uncommon phenomenon is stressed. Findings are severe dyspnea, diaphoresis, wheezing, and sometimes bloodtinged frothy sputum. 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. A number of noncardiac causes of pulmonary edema have been recognized. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of. Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax, pleural effusion or removal of any space occupying lesion. Noncardiogenic pulmonary edema 5minute emergency consult. Reexpansion pulmonary edema rpe is a rare form of noncardiogenic pulmonary edema that can result after prompt reexpansion of a chronically collapsed lung lobe. However, it can be encountered under various clinical conditions, in particular after pleural decortication, declotting or excision of a large intrathoracic tumor mass 1, 2. Largevolume thoracentesis and the risk of reexpansion. This fluid collects in the numerous air sacs in the lungs, which makes difficult to breathe. The incidence referred is less than 1%, and mortality can reach up to 20%. Scientific exhibit clinical and radiologic features of.
Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural cavity performed by either thoracentesis or. Several anaphylactic reactions have been reported in response to aspirin therapy, viz asthma, angioneurotic swelling, urticaria, fixed drug eruptions etc. Negative pressure pulmonary edema nppe or postobstructive pulmonary edema is a welldescribed cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. In cardiogenic pulmonary edema, a high pulmonary capillary pressure as estimated clinically from the pulmonary artery wedge pressure is. Cpe reflects the accumulation of fluid with a lowprotein content in the lung interstitium and alveoli as a result of cardiac dysfunction see the image below. Peripheral edema often poses a dilemma for the clinician be cause it. Neurogenic pulmonary edema is related to conditions associated with severe brain injury, such as head trauma,1,2 subarachnoid hemorrhage,3 traumatic.
Pdf reexpansion pulmonary edema partha chakraborty. Spontaneous pneumothorax with complete collapse of left lung. Nov 26, 2014 we describe the case of a patient suffering from reexpansion pulmonary edema rpe after chest drainage for pneumothorax. Pulmonary edema simple english wikipedia, the free encyclopedia. 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. The total volume drained was calculated to be 55 l. 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 free download as powerpoint presentation. Largevolume thoracentesis and the risk of reexpansion pulmonary edema. On the left, there is a large rightsided pneumothorax white arrows. Normally, the lungs fill with air when a person breathes in. 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.
Pulmonary edema is fluid accumulation in the tissue and air spaces of the lungs. Furosemide and opioids have not been shown to improve the outcomes of ems patients with pulmonary edema. Reexpansion pulmonary edema following thoracentesis. Reexpansion pulmonary edema may be considered an iatrogenic complication due to rapid emptying of the pleural cavity. Acute pulmonary oedema management in general practice racgp. The evolution of reexpansion pulmonary edema is variable, and may occur from a spontaneous resolution to a lethal respiratory failure. Right mid and lower zone alveolar opacity developing acutely post pleural tap with drainage of a large right pleural effusion. Reexpansion pulmonary edema is a potentially lifethreatening complication of lung reexpansion after thoracentesis or tube thoracostomy. Unilateral pulmonary edema radiology reference article. There are no current australian data on the incidence of acute pulmonary oedema or heart failure. Avoid nitroglycerin in any patient who has used viagra sildenafil or levitra vardenafil in the past 24. Clinical presentations include cough, chest discomfort and hypoxemia. 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.
Acute pulmonary oedema is a life threatening emergency that requires. Ipsilateral reexpansion pulmonary edema after drainage of. Cardiac output increases prior to development of pulmonary edema after reexpansion of spon taneous pneumothorax. Pulmonary edema is acute, severe left ventricular failure with pulmonary venous hypertension and alveolar flooding. Unilateral reexpansion pulmonary edema of the left lung. Even though this historically has been a mainstay of ems treatment, it is no longer routinely recommended. Subsequently, the patient became hypoxic, requiring supplemental oxygen via nonrebreather mask.
Here we report a new management modality that is very useful for a patient with rpe. Reexpansion pulmonary edema the journal of the american. A case of pulmonary edema following reexpansion of a collapsed lung due to pneumothorax is described and illustrated. Reexpansion pulmonary edema can be a complication of thoracentesis. Reexpansion pulmonary edema rpe is a rare complication of therapeutic thoracentesis. Reexpansion pulmonary edema rpe is a serious complication of minimally invasive cardiac surgery mics through the right minithoracotomy. Diagnosis and management of cardiogenic pulmonary edema. Unfortunately, there is no definitive treatment modality for rpe. Teixeira3, marcelo alexandre costa vaz3, evaldo marchi3 reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Reexpansion pulmonary edema after therapeutic thoracentesis. Severe reexpansion pulmonary edema induced by onelung ventilation yuki sugiyama md phd, fumiko shimizu md, sari shimizu md, masatoshi urasawa md, satoshi tanaka md phd, and mikito kawamata md we present 2 cases of severe reexpansion pulmonary edema rpe after onelung ventilation olv for thoracic surgery.
However, pulmonary edema may also demonstrate unusual findings. It occurs following 1% of pneumothorax reexpansions or thoracentesis procedures. Apr 08, 2011 reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. Pulmonary edema is the result of an imbalance between the forces that drive fluid into the alveoli and the mechanisms for its removal. Intensive care unit, department of internal medicine, university hospital, ramistrasse. Pdf reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. The onset of pulmonary edema can be delayed by up to 24 hours in some cases. Reexpansion pulmonary edema rpe is an uncommon complication following rapid reexpansion of the lungs, and the most common disorder associated with rpe is spontaneous pneumothorax. 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 characterised by dyspnoea and hypoxia secondary to fluid accumulation in the lungs which impairs gas exchange and lung compliance. Get a printable copy pdf file of the complete article 772k, or click on a page image below to browse page by page. Pulmonary edema pulmonary describes the lung tissue, and edema refers to an excessive fluid volume in the vessels that leaks into interstitial spaces. Pdf reexpansion pulmonary edema after treatment of. Get a printable copy pdf file of the complete article 2.
Get a printable copy pdf file of the complete article 714k, or click on a page image below to browse page by page. Severe reexpansion pulmonary edema induced by onelung. 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. Risk factors for this condition include a young age, a long duration of lung. Reexpansion pulmonary edema repe is an uncommon complication after reinflation of a collapsed lung. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Full text full text is available as a scanned copy of the original print version. There are many accounts of repe occurring in adults, but to my knowledge, this problem has not been reported in. Update reexpansion pulmonary edema eduardo henrique genofre1, francisco s.
The role of tissue reperfusion in the reexpansion injury of the lungs. Pulmonary edema describes lung tissue that contains an abnormal amount of extravascular fluid. Pulmonary edema pulmonary oedema in british english is fluid in the lungs pulmonary means lungs. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are.
The high mortality rate, reported up to 21%, presses the issue for finding adequate prevention and treatment. Diagnosis and management of cardiogenic pulmonary edema idrus alwi department of internal medicine, faculty of medicine, university of indonesia dr. Edema occurs when an excessive volume of fluid accumulates in the tissues, either within cells cellular edema or within the collagenmucopolysaccharide. It is a condition which is caused by excess fluid accumulation.
It is denoted by the occurrence of unilateral pulmonary edema in a lung that has been speedily reinflated following a variable duration of collapse secondary to a pleural. In this article, i present my views on the history, clinical features, morphophysiological features, pathogenesis, and treatment of rpe. This report demonstrates that an increase in the lungs capillary permeability to protein is at least part of the explanation of reexpansion pulmonary edema theories relying solely on changes in. Reexpansion pulmonary edema jama pediatrics jama network. Reexpansion pulmonary edema after chest drainage for. Managing acute pulmonary oedema australian prescriber. Early diagnosis is crucial, since prognosis depends on early recognition and prompt treatment. This condition is recognized to occur more frequently in patients under the age of 40 years, but there has been no detailed analysis of reported pediatric cases of rpe to date. Contralateral reexpansion pulmonary edema with ipsilateral collapsed lung after pleural effusion drainage.
The relationship between pleural pressures and changes in pulmonary function after therapeutic thoracentesis. Therefore, early recognition of signs and symptoms is important since inadequate or delayed. Reexpansion pulmonary edema following thoracentesis cmaj. Management of heart failure in the emergency department setting.
The appearance and clinical setting suggest reexpansion pulmonary edema. 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. This condition is a relatively unknown complication of intercostal chest drainage and is potentially lethal in 20% of cases. Get a printable copy pdf file of the complete article 1. Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. When the injury to the lung is primarily one sided, conventional modes of ventilation can be ineffective and at times harmful. Thus, it is unusual to find pulmonary edema when hypoalbuminemia is the only abnormality. Apr 24, 2019 reexpansion pulmonary edema after largevolume thoracentesis. Repeated chest xray imaging revealed increased alveolar opacification of the right lung consistent with pulmonary edema.
Neurogenic pulmonary edema npe is a clinical syndrome characterized by the acute onset of pulmonary edema following a significant central nervous system cns insult. Although most patients completely recover within five to seven days, severe reexpansion pulmonary edema can lead to sequestration of large quantities of fluid in the lung, which may result in shock and possibly death. Aspirininduced noncardiogenic pulmonary edema sir, aspirin is a nonselective inhibitor of cyclooxygenase cox enzyme, which inhibits production of prostaglandins. High altitude pulmonary oedema swiss medical weekly. 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. Unilateral reexpansion pulmonary edema rpe is a complication described after a pleural drainage. In this article, we describe the clinical and radiologic features of pulmonary edema in a series of 80 patients who were seen over a 10year period in the intensive care units and emergency department at our institution. Infarction of lung due to iatrogenic pulmonary embolism. Reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. As reexpansion mechanical injury and ischemia reperfusion injury to the collapsed lung are possible mechanisms, we introduced a preventive protocol that consists of intermittent ventilation of the right lung, restoration of bilateral ventilation.
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