New classification and clinical characteristics of reexpansion pulmonary edema after treatment of spontaneous pneumothorax

Kim, Yun Kwon; Kim, Hyun; Lee, Christopher C.; Choi, Han Joo; Lee, Kang Hyun; Hwang, Sung Oh; Oh, Joong Hwan; Lee, Young Han; Singer, Adam J.

doi:10.1016/j.ajem.2008.07.036

« Previous Next »American Journal of Emergency Medicine
Volume 27, Issue 8 , Pages 961-967, October 2009

New classification and clinical characteristics of reexpansion pulmonary edema after treatment of spontaneous pneumothorax

Yun Kwon Kim, MD
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
Hyun Kim, MD
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
- Corresponding author. Tel.: +82 33 741 1614; fax: +82 33 732 3030.
Christopher C. Lee, MD
- Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
Han Joo Choi, MD
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
Kang Hyun Lee, MD
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
Sung Oh Hwang, MD
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
Joong Hwan Oh, MD
- Department of Thoracic Surgery, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
Young Han Lee, MD
- Department of Radiology, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
Adam J. Singer, MD
- Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

Received 25 June 2008; received in revised form 28 July 2008; accepted 29 July 2008.

Abstract

Objective

Reexpansion pulmonary edema (REPE) is a rare yet sometimes fatal complication associated with the treatment of lung diseases such as pleural effusion, pneumothorax, and hemothorax. The current study summarizes our experience with REPE for a 3-year period.

Methods

We prospectively collected demographic and clinical data on consecutive patients presenting to an academic university-based emergency department with spontaneous pneumothorax that was treated with closed thoracostomy for a 3-year period.

Results

Eighty-four study patients were enrolled between December 2002 and September 2005. Reexpansion pulmonary edema developed in 25 of 84 (29.8% [95% confidence interval, 21.0-40.2]) patients. Many cases of REPE were small and asymptomatic and only diagnosed on computed tomography of the chest. There was only one death (1.2% [95% confidence interval, A to B]). Reexpansion pulmonary edema was associated with patients with larger pneumothoraces without fibrotic changes and with patients with hypoxia and fibrotic changes. Classic REPE as seen on chest radiograph was 16 (19.0%) in 84 patients. Diffuse REPE as seen only on computed tomography and involved more than 1 lobe was 1 (1.2%) in 84 patients. Isolated REPE as seen only on computed tomography and limited to lesser than 1 lobe was 8 (9.5%) in 84 patients.

Conclusions

The rate of REPE after tube thoracostomy of spontaneous pneumothorax is greater than previously reported and often asymptomatic. The risk of developing REPE is greater with larger pneumothorax, especially in patients without fibrotic lung changes, and with hypoxia in patients with fibrotic changes.