[Re-expansion pulmonary edema (RPE) during surgery for intraabdominal giant tumor]

A 50-year-old woman with massive ovarian cancer underwent a tumor resection and lymph node resection. Oxygenation was impaired preoperatively and chest X-ray film and computed tomogram revealed an elevation of the two diaphragms and atelectasis of the lower parts of the lungs. Induction of anesthesia was uneventful. During the surgery, oxygenation was improved after laparotomy but deteriorated again about 90 minutes after the tumor resection. Just before the termination of the surgery, we found bubbly sputum coming out from the tracheal tube. We had her chest X-ray taken and found bilateral consolidation of the lower parts of the lungs with air-bronchogram and loss of diaphragm profiles. The diagnosis of RPE was made and she was, transferred to ICU without extubation. Evacuation of pneumothorax or pleural effusion is the most common cause of RPE; but, removal of the intraabdominal mass would provide a good chance for RPE. Although, slow expansion of the collapsed lungs to prevent RPE is recommended, this consideration may not always be warranted.