Reexpansion unilateral pulmonary edema after drainage of pneumothorax: case report

Re-expansion pulmonary edema (REPE) is a rare but potentially fatal complication that occurs after rapid re-expansion of a collapsed lung, particularly following pleural drainage. The exact pathophysiology remains poorly understood, but several interrelated mechanisms are involved, such as fluid overload and alteration of the alveolar-capillary barrier. The mortality rate varies between 5% and 20% according to the literature. Early recognition and effective treatment of this complication is essential to reduce the associated morbidity and mortality.

A 22-year-old patient suffered a fall from the third floor. Imaging revealed several fractures, a subgaleal hematoma and a right pneumothorax. After surgery to stabilize the fractures, a worsening of the pneumothorax necessitated pleural drainage without aspiration. One hour after drainage, the patient developed respiratory distress and an X-ray showed unilateral pulmonary edema. Treatment with continuous positive airway pressure was initiated, resulting in rapid improvement and disappearance of radiological signs. The chest tube was removed and the patient was transferred to the trauma unit.

REPE usually occurs after rapid re-expansion of the lung. The main risk factors include young age, prolonged lung collapse and excessive drainage. Treatment is preventive (slow drainage, without aspiration) and symptomatic (oxygen therapy, assisted ventilation if necessary).

REPE is a little-known but potentially fatal complication of thoracic drainage. It is essential to understand the risk factors and adopt appropriate preventive measures. Early identification and prompt management are crucial to avoid a severe course. Despite advances in our understanding of EPR, further research is needed to better elucidate its mechanisms and optimize its management.