Re-expansion pulmonary edema
Re-expansion pulmonary edema is an uncommon but important cause of non-cardiogenic pulmonary edema.
Clinical presentation
The condition occurs in the setting of rapid expansion of a collapsed lung, with acute onset shortness of breath usually occurring within hours of re-expansion. The onset of pulmonary edema can be delayed by up to 24 hours in some cases. It occurs following ~1% of pneumothorax re-expansions or thoracentesis procedures.
Pathology
The exact underlying mechanism is unknown but is thought to be a form of permeability edema related to endothelial changes occurring when the lung has been collapsed for 3 or more days.
Risk factors
Rapid lung re-expansion in the following settings :
- large pneumothoraces
- large volume pleural drainage (>3 L)
- youngpatients
- patients in whom the lung has been collapsed for over 7 days
Radiographic features
Plain radiograph
- alveolar (air-space) opacity
- usually unilateral in those portions of the lung that were previously collapsed
- rarely edema can develop in the contralateral lung
- the clinical setting is critical to making the diagnosis
- edema may persist for several days and up to one week
CT
Not surprisingly, re-expansion edema appears as regions of ground glass opacification. It may be peripheral in distribution and associated with smooth interstitial thickening .
Prevention
The British Thoracic Societyguidelines suggest that <1.5 L of pleural fluid be drainedat a time. Drainage catheters can be intermittently plugged to prevent rapid lung re-expansion. Rapid re-expansion of pneumothoraces is less easily controlled and caution shouldbe taken to avoid high negative intrapleural pressures.
See also
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Reexpansionslungenödem:
