Presentation
History of dyspnea and generalized chest pain worsening over the past week. Patient denied any recent trauma or history of any cardiopulmonary diseases.
Patient Data
Initial portable AP chest radiograph demonstrates a large right-sided pneumothorax with complete collapse of the right lung. The absence of mass-effect on the midline structures suggests spontaneous pneumothorax rather than tension pneumothorax.
Subsequent portable AP chest radiograph following evacuation shows a small-bore chest tube in the right hemithorax with a tiny residual apical pneumothorax. Notably, though the right lung is almost completely re-expanded there are patchy alveolar opacities, particularly in the upper and lower right lung fields.
A noncontrast CT chest was obtained to further characterize the right lung opacities. There are patchy ground glass opacities distributed throughout the right lung, somewhat preferentially affecting the perihilar and dependent regions.
Follow-up portable AP chest radiograph one day later shows rapidly resolving alveolar opacities in the right perihilar region.
Case Discussion
This is likely a case of re-expansion pulmonary edema following an evacuation of a spontaneous pneumothorax. Relatively rapid resolution of pulmonary findings on CT with reduction of pneumothorax is what favors re-expansion edema rather than pulmonary hemorrhage or contusion.
Key learning points:
- Re-expansion pulmonary edema is a rare but potentially life-threatening complication of pneumothorax re-expansion and thoracocentesis procedures.
- Despite being more common in individuals age 20-39 1, it may occur in patients over the age of 40.
Co-Authors:
- Roger Rozzi, DO
- Saud Ahmed, MD
- David Gabbert, DO
- Brittany Cloud, DO
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