Re-Expansion Pulmonary Edema: a Severe Complication of Thoracic Surgery

Abstract

Re-expansion pulmonary edema is a relatively rare condition that develops during rapid expansion of a collapsed lung due to pleural effusion, pneumothorax or atelectasis. The exact pathophysiology of this complication is still unknown but involves histological abnormalities of the pulmonary microvessels as well as mechanical stress during re-expansion. The evolution under artificial ventilation with positive expiratory pressure has improved the prognosis but it remains potentially fatal with a mortality that can reach 21%. We herein describe the case of a 61-year-old man, a smoker, who presented a suspicious apical mass of the right upper lobe with tumoral invasion of the superior vena cava associated with a right hydropneumothorax who was scheduled for a thoracoscopic biopsy. The patient benefited from a surgical drainage of the hydropneumothorax and was complicated by a postoperative respiratory distress, which revealed a re-expansion pulmonary edema. Patient management using noninvasive ventilation and diuretics was unsuccessful. The patient’s condition worsened afterwards complicated thereafter with a state of shock and death by multiorgan failure . Keywords: Re-expansion pulmonary edema, thoracic surgery