Re-expansion pulmonary oedema

Case contributed by Liz Silverstone
Diagnosis certain

Presentation

Routine follow-up from clinic.

Patient Data

Age: 50 years
Gender: Male
x-ray
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Info

Large right hydropneumothorax and apical bulla.

CT-guided drain

ct
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Intercostal drain (attached to underwater seal).

Large hydropneumothorax and relaxation atelectasis.

+ 50 minutes

x-ray
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Minimal residual pneumothorax.

The mediastinum has shifted to the right.

+ 5 hours

x-ray
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Rapid response call for chest discomfort and dyspnoea.

Dense right lung consolidation and large apical bullae.

Chest drain in situ.

Case Discussion

Patient recovered and was discharged 3 days later.

Re-expansion pulmonary oedema can be bilateral and fatal with a high mortality rate. Risk factors include chronic collapse of the lung. The duration was unknown in this case.

The rate of re-expansion should be limited to 1-1.5 L/hour, however the volume cannot be measured if an underwater seal is used.

Intermittent measured aspiration may prevent re-expansion pulmonary oedema.

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