Re-expansion pulmonary oedema is an uncommon but important cause of non-cardiogenic pulmonary oedema.
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 oedema can be delayed by up to 24 hours in some cases. It occurs following approximately 1% of pneumothorax re-expansions or thoracentesis procedures.
The exact underlying mechanism is unknown but is thought to be a form of permeability oedema related to endothelial changes occurring when the lung has been collapsed for 3 or more days.
Rapid lung re-expansion in the following settings 1:
- large pneumothoraces
- large volume pleural drainage (>3 litres)
- young patients
- patients in whom the lung has been collapsed for over 7 days
- alveolar (air-space) opacity
- usually unilateral in those portions of the lung that were previously collapsed
- rarely oedema can develop in the contralateral lung
- the clinical setting is critical to making the diagnosis
- oedema may persist for several days and up to one week
Not surprisingly, re-expansion oedema appears as regions of ground glass opacification. It may be peripheral in distribution and associated with smooth interstitial thickening 2.
The British Thoracic Society guidelines suggest that less than 1.5 litres of pleural fluid be drained at 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 should be taken to avoid high negative intrapleural pressures.
- 1. Echevarria C, Twomey D, Dunning J et-al. Does re-expansion pulmonary oedema exist? Interact Cardiovasc Thorac Surg. 2008;7 (3): 485-9. doi:10.1510/icvts.2008.178087 - Pubmed citation
- 2. Baik JH, Ahn MI, Park YH et-al. High-resolution CT findings of re-expansion pulmonary edema. Korean J Radiol. 11 (2): 164-8. doi:10.3348/kjr.2010.11.2.164 - Free text at pubmed - Pubmed citation