Clinical presentation the condition occurs in the setting of rapid expansion of a collapsed lung, with acute onset shortness of breath usually o. Even though this historically has been a mainstay of ems treatment, it is no longer routinely recommended. Pulmonary edema is fluid accumulation in the tissue and air spaces of the lungs. Jul 17, 2017 reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung. Reexpansion pulmonary oedema rpe is a rare but potentially fatal complication with no clear cut guidelines for its management. Management of heart failure in the emergency department setting. The high mortality rate, reported up to 21%, presses the issue for finding adequate prevention and treatment. 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. Reexpansion pulmonary edema is a potentially lifethreatening complication of lung reexpansion after thoracentesis or tube thoracostomy. The majority of patients with rpe associated with pneumothorax have been adults. 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. Pulmonary edema cardiovascular disorders msd manual. Intensive care unit, department of internal medicine, university hospital, ramistrasse. Reexpansion pulmonary edema jama pediatrics jama network.
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. Peripheral edema often poses a dilemma for the clinician be cause it. Reexpansion pulmonary edema free download as powerpoint presentation. Reexpansion pulmonary edema is a noncardiogenic pulmonary edema that occurs in the setting of rapid expansion of a collapsed lung.
Reexpansion pulmonary edema may be considered an iatrogenic complication due to rapid emptying of the pleural cavity. Acute respiratory distress syndrome of the contralateral lung after reexpansion pulmonary edema of. The incidence referred is less than 1%, and mortality can reach up to 20%. Noncardiogenic pulmonary edema 5minute emergency consult. 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. Reexpansion pulmonary edema after therapeutic thoracentesis. Pdf reexpansion pulmonary edema after treatment of. We report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. There are many accounts of repe occurring in adults, but to my knowledge, this problem has not been reported in.
Pulmonary edema simple english wikipedia, the free encyclopedia. Independent lung ventilation for reexpansion pulmonary. Acute unilateral reexpansion pulmonary edema after. Unfortunately, there is no definitive treatment modality for rpe. Reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly. There are no current australian data on the incidence of acute pulmonary oedema or heart failure. The role of tissue reperfusion in the reexpansion injury of the lungs. The evolution of reexpansion pulmonary edema is variable, and may occur from a spontaneous resolution to a lethal respiratory failure. Neurogenic pulmonary edema npe is a clinical syndrome characterized by the acute onset of pulmonary edema following a significant central nervous system cns insult. Aspirininduced noncardiogenic pulmonary edema sir, aspirin is a nonselective inhibitor of cyclooxygenase cox enzyme, which inhibits production of prostaglandins. Reexpansion pulmonary edema repe is an uncommon complication after reinflation of a collapsed lung.
Thus, it is unusual to find pulmonary edema when hypoalbuminemia is the only abnormality. Pdf reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Reexpansion pulmonary edema radiology reference article. 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. It is characterised by dyspnoea and hypoxia secondary to fluid accumulation in the lungs which impairs gas exchange and lung compliance.
Dec 21, 2017 cardiogenic pulmonary edema cpe is defined as pulmonary edema due to increased capillary hydrostatic pressure secondary to elevated pulmonary venous pressure. The patient recovered completely after 2 days of supportive treatment and a further chest xray showed clear lung fields bilaterally. Acute pulmonary edema, congestive heart failure and cardiogenic shock are a spectrum of diseases and should be considered and managed differently. Apr 24, 2019 reexpansion pulmonary edema after largevolume thoracentesis. Get a printable copy pdf file of the complete article 1. Pulmonary edema is the result of an imbalance between the forces that drive fluid into the alveoli and the mechanisms for its removal. The relationship between pleural pressures and changes in pulmonary function after therapeutic thoracentesis. Reexpansion pulmonary edema in a boy with spontaneous. Avoid nitroglycerin in any patient who has used viagra sildenafil or levitra vardenafil in the past 24. Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. Pulmonary edema pulmonary oedema in british english is fluid in the lungs pulmonary means lungs.
Learning radiology reexpansion, reexpansion, pulmonary, edema. The total volume drained was calculated to be 55 l. Effectiveness of ultrasound in acute pulmonary edema diagnosis in. Get a printable copy pdf file of the complete article 772k, or click on a page image below to browse page by page. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are. Reexpansion pulmonary edema can be a complication of thoracentesis.
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. Reexpansion pulmonary edema rpe is a serious complication of minimally invasive cardiac surgery mics through the right minithoracotomy. Pulmonary edema india pdf ppt case reports symptoms. 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. It is a condition which is caused by excess fluid accumulation. Other causes include pulmonary embolus, anaemia and renal artery stenosis. However, pulmonary edema may also demonstrate unusual findings.
Full text full text is available as a scanned copy of the original print version. 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. Reexpansion pulmonary edema is an uncommon but important cause of noncardiogenic pulmonary edema. Largevolume thoracentesis and the risk of reexpansion. 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. In cardiogenic pulmonary edema, a high pulmonary capillary pressure as estimated clinically from the pulmonary artery wedge pressure is. Here we report a new management modality that is very useful for a patient with rpe. An hour after chest tube insertion red arrows, there is now airspace disease in the right lung yellow arrow, which has been reexpanded. What links here related changes upload file special pages permanent link page information wikidata. Reexpansion pulmonary edema after chest drainage 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. Pulmonary edema is acute, severe left ventricular failure with pulmonary venous hypertension and alveolar flooding. Apr 08, 2011 reexpansion pulmonary edema rpe is a relatively rare condition which develops when a collapsed lung is allowed to expand suddenly.
The onset of pulmonary edema can be delayed by up to 24 hours in some cases. Reexpansion pulmonary edema is an unusual, but commonly fatal, clinical state. Jul 29, 2011 management the immediate objective of treatment is to improve oxygenation and reduce pulmonary congestion. 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.
Diagnosis and management of cardiogenic pulmonary edema. Managing acute pulmonary oedema australian prescriber. Pdf reexpansion pulmonary edema partha chakraborty. Therefore, early recognition of signs and symptoms is important since inadequate or delayed. Normally, the lungs fill with air when a person breathes in. It leads to impaired gas exchange and may cause respiratory failure. The appearance and clinical setting suggest reexpansion pulmonary edema.
Right mid and lower zone alveolar opacity developing acutely post pleural tap with drainage of a large right pleural effusion. Based on the clinical and radiological findings, a diagnosis of reexpansion pulmonary oedema was made. Acute pulmonary oedema is a life threatening emergency that requires. In this article, i present my views on the history, clinical features, morphophysiological features, pathogenesis, and treatment of rpe. 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. Repeated chest xray imaging revealed increased alveolar opacification of the right lung consistent with pulmonary edema.
The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased pulmonary surfactant levels and a proinflammatory status are putative mechanisms. 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. Get a printable copy pdf file of the complete article 714k, or click on a page image below to browse page by page. Pulmonary edema describes lung tissue that contains an abnormal amount of extravascular fluid. Prevention of reexpansion pulmonary edema and ischemia. Unilateral reexpansion pulmonary edema rpe is a complication described after a pleural drainage. 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. Links to pubmed are also available for selected references. Reexpansion pulmonary edema the journal of the american. Reexpansion pulmonary edema following thoracentesis cmaj. Acute pulmonary oedema management in general practice racgp.
This results in pulmonary venous constriction shifting blood from the systemic to the pulmonic circulation, increase in pulmonary hydrostatic pressure and finally edema. Findings are severe dyspnea, diaphoresis, wheezing, and sometimes bloodtinged frothy sputum. 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. It occurs following 1% of pneumothorax reexpansions or thoracentesis procedures. Early diagnosis is crucial, since prognosis depends on early recognition and prompt treatment.
Reexpansion pulmonary edema is an uncommon complication following drainage of a pneumothorax, pleural effusion or removal of any space occupying lesion. 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. Reexpansion pulmonary edema by talal alzahrani, nawaf. Diagnosis and management of cardiogenic pulmonary edema idrus alwi department of internal medicine, faculty of medicine, university of indonesia dr. Contralateral reexpansion pulmonary edema with ipsilateral collapsed lung after pleural effusion drainage. Update reexpansion pulmonary edema eduardo henrique genofre1, francisco s. Reexpansion pulmonary edema is a rare complication resulting from rapid emptying of air or liquid from the pleural cavity performed by either thoracentesis or. Scientific exhibit clinical and radiologic features of. Largevolume thoracentesis and the risk of reexpansion pulmonary edema. Histological abnormalities of the pulmonary microvessels as well as mechanical stress exerted during reexpansion are implicated in the pathogenesis of this disorder.
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. High altitude pulmonary oedema swiss medical weekly. In cardiogenic pulmonary edema, the central therapeutic focus is to decrease preload by aggressive diuresis using loop diuretics. 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.
The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased. Risk factors for this condition include a young age, a long duration of lung. Reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. Unilateral reexpansion pulmonary edema of the left lung. Furosemide and opioids have not been shown to improve the outcomes of ems patients with pulmonary edema. Teixeira3, marcelo alexandre costa vaz3, evaldo marchi3 reexpansion pulmonary edema rpe is a rare, but frequently lethal, clinical condition. A number of noncardiac causes of pulmonary edema have been recognized.
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. 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. Accumulation of blood in the pulmonary vasculature as a result of the inability of the left ventricle to pump blood forward adequately. Reexpansion pulmonary edema rpe is a rare complication of therapeutic thoracentesis. Ipsilateral reexpansion pulmonary edema after drainage of. Pulmonary edema pulmonary describes the lung tissue, and edema refers to an excessive fluid volume in the vessels that leaks into interstitial spaces. On the left, there is a large rightsided pneumothorax white arrows.
Severe reexpansion pulmonary edema induced by onelung. Subsequently, the patient became hypoxic, requiring supplemental oxygen via nonrebreather mask. Nov 26, 2014 we describe the case of a patient suffering from reexpansion pulmonary edema rpe after chest drainage for pneumothorax. Get a printable copy pdf file of the complete article 2. Several anaphylactic reactions have been reported in response to aspirin therapy, viz asthma, angioneurotic swelling, urticaria, fixed drug eruptions etc. The patient received supplemental oxygen via a nonrebreather face mask to compensate for hypoxemia.
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. 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. In most of the cases, heart problems are caused due to pulmonary edema. A case of pulmonary edema following reexpansion of a collapsed lung due to pneumothorax is described and illustrated. The importance of recognizing this relatively uncommon phenomenon is stressed. Clinical presentations include cough, chest discomfort and hypoxemia. 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. Reexpansion pulmonary edema repe is an uncommon problem that afflicts the reexpanded lung after evacuation of a large pneumothorax or pleural effusion. It is hypothesized that the regurgitation jet is directed to. Edema occurs when an excessive volume of fluid accumulates in the tissues, either within cells cellular edema or within the collagenmucopolysaccharide. From the alveoli in the lungs, oxygen goes into the blood.
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. Neurogenic pulmonary edema is related to conditions associated with severe brain injury, such as head trauma,1,2 subarachnoid hemorrhage,3 traumatic. Cardiac output increases prior to development of pulmonary edema after reexpansion of spon taneous pneumothorax. Histological abnormalities of the pulmonary microvessels in a chronically collapsed lung will cause rpe, as well as mechanical stress exerted during reexpansion. Mechanical stresses,surfactant abnormalities,neutrophil accumulation, ventilatorinduced injury,and ischemiareperfusion injury may all contribute. Unilateral pulmonary edema radiology reference article. 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. When the injury to the lung is primarily one sided, conventional modes of ventilation can be ineffective and at times harmful. 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. This fluid collects in the numerous air sacs in the lungs, which makes difficult to breathe. Reexpansion pulmonary edema following thoracentesis. Reexpansion pulmonary edema rpe is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of lung collapse. This condition is a relatively unknown complication of intercostal chest drainage and is potentially lethal in 20% of cases. Spontaneous pneumothorax with complete collapse of left lung.
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