Severe re-expansion pulmonary edema despite incomplete re-expansion of the lung: a case report

BACKGROUND: Re-expansion pulmonary edema is a rare but potentially fatal (mortality up to 20%) complication of the rapid removal of air, fluid, or other space-occupying lesion from the pleural cavity. This case report highlights the fact that this complication is much more likely to occur when treating large, chronic pneumothoraces, and can occur even if the lung fails to fully re-expand. CASE PRESENTATION: A 49-year-old white British man presented to the emergency department with sudden onset of shortness of breath 5 days prior to admission. A left-sided pneumothorax was suspected on clinical examination, and chest X-ray confirmed a large, left-sided pneumothorax. A 12 French gauge chest drain was inserted and connected to an underwater seal. Shortly after insertion of the drain, the patient’s condition deteriorated rapidly with tachypnea and severe hypoxemia. A diagnosis of re-expansion pulmonary edema was made, and the patient was treated with high-flow oxygen and continuous positive airways pressure. CONCLUSIONS: This case report serves as a reminder of the morbidity and potential mortality associated with a commonly performed medical procedure, and reveals a lack of clear and precise guidance on the management of large, chronic (> 72 hours) pneumothoraces in the current British Thoracic Society pleural disease guidelines.