Article

Reexpansion Pulmonary Edema Computed Tomography Findings in 22 Patients

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

To determine the computed tomography (CT) imaging features of reexpansion pulmonary edema. A retrospective review was performed of 22 consecutive patients with clinical and radiologic features consistent with reexpansion pulmonary edema (14 male, 8 female; mean age, 56±22.8 y; range, 19 to 82 y) and with available CT scan images within 3 days of drainage of pleural effusion or pneumothorax. The CT images were reviewed by 2 chest radiologists with consensus for the presence, extent, and distribution of ground-glass opacities, septal thickening, consolidation, presence of persistent areas of atelectasis, vascular caliber, linear opacities, residual midline shift, and trapped lung. CT findings included ipsilateral ground-glass opacities (n=21, 95%), smooth septal thickening (n=17, 77%), consolidation (n=14, 68%), and persistent foci of atelectasis (n=19, 86%). Less commonly seen features included air-bronchograms (n=6, 27%) and nodules (n=5, 23%) [centrilobular, n=4 (18%); random, n=1 (4.5%)]. Contralateral abnormalities were seen in 8 cases (36%) and included ground-glass opacities in 6 patients, interlobular septal thickening in 3 patients (13.6%), and consolidation in 3 patients. The most common CT findings of reexpansion pulmonary edema include ipsilateral ground-glass opacities, septal thickening, foci of consolidation, and areas of atelectasis.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Reexpansion pulmonary edema (RPE) is a rare and potentially fatal clinical entity. It usually occurs when a chronically collapsed lung is rapidly reexpanded after the evacuation of large amounts of fluid or air from the pleural space, often using high negative intrapleural pressures (1)(2)(3)(4)(5) . ...
... Chest computerized tomography may show ground-glass opacity, residual pleural effusion, atelectasis, interlobar septum thickening, consolidations, air bronchograms, and pulmonary nodules. Nearly half of patients show diffuse involvement of the previously collapsed lung (4) and bilateral pulmonary involvement is rarely observed (1,4,5,7,10) . The clinical picture of the patient described herein included respiratory insufficiency and need for mechanical ventilation with high parameters, similarly to some of the reported cases of children with RPE. ...
... Chest computerized tomography may show ground-glass opacity, residual pleural effusion, atelectasis, interlobar septum thickening, consolidations, air bronchograms, and pulmonary nodules. Nearly half of patients show diffuse involvement of the previously collapsed lung (4) and bilateral pulmonary involvement is rarely observed (1,4,5,7,10) . The clinical picture of the patient described herein included respiratory insufficiency and need for mechanical ventilation with high parameters, similarly to some of the reported cases of children with RPE. ...
Article
Full-text available
OBJECTIVE To present a case of a patient with clinical and radiological features of reexpansion pulmonary edema, a rare and potentially fatal disease. CASE DESCRIPTION An 11-year-old boy presenting fever, clinical signs and radiological features of large pleural effusion initially treated as a parapneumonic process. Due to clinical deterioration he underwent tube thoracostomy, with evacuation of 3,000 mL of fluid; he shortly presented acute respiratory insufficiency and needed mechanical ventilation. He had an atypical evolution (extubated twice with no satisfactory response). Computerized tomography findings matched those of reexpansion edema. He recovered satisfactorily after intensive care, and pleural tuberculosis was diagnosed afterwards. COMMENTS Despite its rareness in the pediatric population (only five case reports gathered), the knowledge of this pathology and its prevention is very important, due to high mortality rates. It is recommended, among other measures, slow evacuation of the pleural effusion, not removing more than 1,500 mL of fluid at once.
... 2-4,6-15 CXR and CT will show features of worsening opacities mainly on the ipsilateral lung but possibly bilaterally as in our patient. [13][14][15] Management and Prevention RPE has no specific treatment. Asymptomatic and mildly symptomatic patients may not be diagnosed and will not require treatment other than close monitoring if diagnosed. ...
... Corticosteroids may ameliorate the pro-inflammatory state and were given to some children but their benefit is not proven. 1,2,4,[9][10][11][12][13][14][15][16] Prevention strategies include timely and limited (<1500 mL fluid at a time and avoiding excessive negative pressure for pneumothorax) drainage of fluid, slow rate of drainage, and possibly the use of ultrasound to guide management of fluid drainage. 9,10,17 RPE is a serious complication with a fatality rate reaching up to 20%, thus early consideration and prompt diagnosis and treatment are warranted. ...
Article
Full-text available
Background: Re-expansion Pulmonary Edema (RPE) is a non-cardiogenic form of pulmonary edema which occurs following rapid lung expansion after drainage of significant pneumothorax or pleural effusion, and rarely following resection of obstructive mediastinal mass. RPE is a rare but potentially fatal phenomenon with only few case reports in the pediatric literature. Methods: We are reporting a case of RPE in a 5-year-old girl following drainage of pneumothorax who succumbed to worsening hypoxemia despite therapy with mechanical ventilation and other supportive care. Conclusion: RPE should be anticipated, and early preventive, diagnostic and therapeutic measures should be instituted in high-risk patients who require significant pleural fluid or air drainage. Keywords: pulmonary edema, re-expansion, pneumothorax, pleural effusion, chest tube, Ethiopia
... Most patients are symptomatic within an hour after pleural drainage, although it can occur at any point within 24 h (10, 21). CT findings most commonly include ipsilateral groundglass opacities, septal thickening, consolidation, and persistent areas of atelectasis (22). Edema most commonly occurs in the ipsilateral lung, but can present in the contralateral lung or bilaterally (22,23). ...
... CT findings most commonly include ipsilateral groundglass opacities, septal thickening, consolidation, and persistent areas of atelectasis (22). Edema most commonly occurs in the ipsilateral lung, but can present in the contralateral lung or bilaterally (22,23). ...
Article
Full-text available
Reexpansion pulmonary edema (RPE) is a rare complication that can occur after rapid reinflation of the lung following thoracentesis of a pleural effusion or chest tube drainage of pneumothorax. The severity in clinical presentation can be widely varied from radiographic changes only to rapidly progressive respiratory failure requiring mechanical ventilation. The quick nature of onset and potential for serious decline in a previously stable patient makes it important to prepare, recognize, diagnose, and appropriately manage patients who develop RPE. The standard treatment for RPE consists of supportive care, and there are certain measures that may be taken to reduce the risk, including limiting the amount drained and avoiding excessive negative pleural pressure. Exactly how to prevent RPE remains unclear, however, and varying recommendations exist. This is a case report of RPE after thoracentesis for a pleural effusion and a brief review of literature to date, including potential preventative strategies.
... Y.L.) and a thoracic surgeon (C.B.P.) without the clinical information of the patients. REPE was defined radiologically as the presence of the following features [7,8]: (1) ipsilateral ground-glass opacities, (2) interlobular septal thickening or intralobular interstitial thickening, (3) consolidation, and (4) atelectasis. Other causes for these findings such as malignancy, pneumonia, and obstructive pneumonopathy were excluded. ...
Article
Full-text available
Reexpansion pulmonary edema (REPE) is known as a rare and fatal complication after tube thoracostomy.Objectives: We investigated the risk factors for the development of REPE in patients with spontaneous pneumothorax. We selected patients who were diagnosed with spontaneous pneumothorax and were initially treated with tube thoracostomy between August 1, 2003 and December 31, 2011. The patients' electronic medical records, including operative notes and chest x-ray and computed tomography scans, were reviewed. REPE developed in 49 of the 306 patients (16.0%). REPE was more common in patients with diabetes (14.3% vs 3.9%, P = 0.004) or tension pneumothorax (46.8% vs 16.2%, P = 0.000). The pneumothorax was larger in patients with REPE than without REPE (57.0 +/- 16.0% vs 34.2 +/- 17.6%, P = 0.000), and the incidence of REPE increased with the size of pneumothorax. On multivariate analysis, diabetes mellitus [(odds ratio (OR) = 9.93, P = 0.003), and the size of pneumothorax (OR = 1.07, P = 0.000) were independent risk factors of REPE. The presence of diabetes increases the risk of REPE development in patients with spontaneous pneumothorax. The risk of REPE also increases significantly with the size of pneumothorax.
... A diagnosis of RPE was made on a radiographic basis. The radiographic criteria included a chest radiograph or CT scan with a new finding of focal ground-glass opacity with a vascular distribution (8). ...
Article
Background: The major risk factor for reexpansion pulmonary edema (RPE) following the treatment of spontaneous pneumothorax is thought to be chronic lung collapse. However, a long-term collapsed lung does not always cause RPE. The purpose of this study was to define other risk factors for RPE among patients undergoing drainage for the treatment of spontaneous pneumothorax. Methods: We retrospectively reviewed all the patients with spontaneous pneumothorax who had been treated at our hospital during a 5-year period. The duration of symptoms, location and size of the pneumothorax, size of the chest tube, and pleural effusion, which can occur coincidentally with pneumothorax, were compared in patients who did and did not experience RPE. Results: Forty patients were underwent drainage for the treatment of a spontaneous pneumothorax between January 2007 and December 2012. RPE developed in 13 of the 40 (32.5%) patients. In the multivariate analysis, the presence of pleural effusion coincident with pneumothorax contributed to the risk for RPE [odds ratios (OR), 1.557; 95% confidence intervals (CI), 1.290-1.880]. The duration of symptoms, location and size of the pneumothorax and size of the chest tube were similar between the groups. Symptomatic RPE was associated with a larger pneumothorax size. Conclusions: The rate of RPE following spontaneous pneumothorax is higher than was previously reported. Our findings suggest the presence of pleural effusion coincidentally with pneumothorax may therefore be a new risk factor for RPE.
... The edema resolves in 5e7 days without remaining radiographic abnormalities [7]. The most common findings on a computed tomography (CT)-scan include ipsilateral ground-glass opacities, septal thickening, foci of consolidation, and areas of atelectasis [8]. RPE is usually a self-limiting disease and most often does not need any intervention [13]. ...
Article
Full-text available
Reexpansion pulmonary edema (RPE) is a rare complication that may occur after treatment of lung collapse caused by pneumothorax, atelectasis or pleural effusion and can be fatal in 20% of cases. The pathogenesis of RPE is probably related to histological changes of the lung parenchyma and reperfusion-damage by free radicals leading to an increased vascular permeability. RPE is often self-limiting and treatment is supportive. A 76-year-old patient was treated by intercostal drainage for a traumatic pneumothorax. Shortly afterwards he developed reexpansion pulmonary edema and was transferred to the intensive care unit for ventilatory support. Gradually, the edema and dyspnea diminished and the patient could be discharged in good clinical condition. RPE is characterized by rapidly progressive respiratory failure and tachycardia after intercostal chest drainage. Early recognition of signs and symptoms of RPE is important to initiate early management and allow for a favorable outcome.
... The remaining 381 patients who underwent MICS with right mini-thoracotomy were included in the cohort. RPO was diagnosed by expert radiologists as a new and apparent unilateral pulmonary oedema on a chest radiography and computed tomography after operation ( Fig. 1A and B) [20,21]. We did not include asymptomatic and uneventful cases with an ambiguous unilateral change, in which radiologists could not conclusively identify postoperative RPO. ...
Article
Re-expansion pulmonary oedema (RPO) sometimes occurs after minimally invasive cardiac surgery (MICS) with single-lung ventilation. However, it has not been widely recognized as a serious complication. The aim of this study is to evaluate the occurrence rate and risk factors of RPO. A total of 381 consecutive patients who underwent MICS with right mini-thoracotomy from March 2005 to October 2013 were retrospectively reviewed. RPO was observed in 8 (2.1%) patients. In the preoperative data, greater percentages of preoperative use of steroid or immunosuppressant were found in patients with RPO (25% [2/8] vs 1% [4/373]; P = 0.0056). In the operative data, significantly longer operation, cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC) times as well as greater percentages of second CPB run were found in patients with RPO (388 ± 80 vs 272 ± 61 min; P < 0.0002, 253 ± 79 vs 158 ± 50 min; P = 0.0009, 162 ± 65 vs 108 ± 38 min; P = 0.020 and 38% [3/8] vs 1.3% [5/373]; P < 0.0003). The overall 30-day mortality rate was 0.8% (3/381) and the 30-day mortality rate of patients with RPO was 12.5% (1/8). Significantly prolonged initial ventilation time, intensive care unit and postoperative hospital stay were observed in patients with RPO (P = 0.0022, <0.0001 and 0.0003, respectively). Multivariate logistic analysis detected preoperative use of steroid or immunosuppressant and prolonged ACC time (≥156 min) as independent risk factors for RPO after MICS (odds ratio [OR]: 87.6 [95% confidence interval, CI: 4.1-2463.8]; P = 0.006 and OR: 36.0 [95% CI: 4.8-731.4]; P < 0.001). RPO should be recognized as one of the most serious complications after MICS with right mini-thoracotomy. More accurate risk factors of prolonged lung malperfusion and steroid use on RPO after MICS should be investigated. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
... [23,24] HRCT findings include ground glass opacities with smooth interlobular septal thickening predominantly seen peripherally and gravity dependent areas or focal areas of consolidation or atelectasis. [25,26] Patient was managed with supplemental oxygen to maintain oxygen level of more than 90%. Patient's symptoms resolved within 24 h. ...
Article
Full-text available
Re-expansion pulmonary edema (RPE) is a rare complication of thoracentesis. Mortality has been reported in 20% of cases. We present a 25-year-old male with 2 days history of right sided chest pain with imaging suggestive of right-sided extensive pneumothorax. Patient developed symptoms consistent with RPE 12 h after placement of intercostal tube which was documented by imaging. Patient received symptomatic management in respiratory care ward with improvement of his symptoms within 24 h and normalization of chest X-ray after 3 days.
... 3 The most common computed tomography findings of RPE include ipsilateral ground-glass opacities, septal thickening, foci of consolidation, and areas of atelectasis. 6 Pathophysiologically, RPE represents a form of increased capillary permeability edema. Other factors implicated in the pathogenesis are hypoxic injury to capillary and alveolar membrane, mechanical stress, and decreased surfactants. ...
... 3 The most common computed tomography findings of RPE include ipsilateral ground-glass opacities, septal thickening, foci of consolidation, and areas of atelectasis. 6 Pathophysiologically, RPE represents a form of increased capillary permeability edema. Other factors implicated in the pathogenesis are hypoxic injury to capillary and alveolar membrane, mechanical stress, and decreased surfactants. ...
Article
Full-text available
Reexpansion pulmonary edema (RPE) is an important cause of unilateral pulmonary edema that rarely occurs following drainage of pleural effusion or pneumothorax. Most patients develop symptoms within an hour of lung expansion. The presentation is usually rapid and dramatic and may be fatal at times. The duration of lung collapse more than 3 days, large-size pneumothorax, rapidity of lung expansion, and application of negative pleural suction are well-known risk factors for the development of RPE. We present here an elderly male with diabetes mellitus who presented with a large pneumothorax and developed RPE shortly after insertion of a chest tube.
... The incidence of re-expansion pulmonary edema after chest drainage in patients with pneumothorax is 14%-17%. 1 The radiologic findings of re-expansion pulmonary edema include ground-glass opacity (GGO), septal thickening, focal consolidation, and atelectasis. 2 Diffuse GGO in these patients may mask pulmonary adenocarcinoma. Therefore, it is very important to rule out pulmonary adenocarcinoma in patients with re-expansion pulmonary edema. ...
Article
Full-text available
Re‐expansion pulmonary edema is a rare complication that may occur after chest drainage performed for pneumothorax. This condition manifests as areas of ground‐glass opacities (GGO) and septal thickening on imaging studies. In the case reported here, chest computed tomography (CT) showed diffuse ground‐glass opacity secondary to ruptured bullae in a patient who underwent chest tube drainage for pneumothorax, suggesting re‐expansion pulmonary edema. Histopathological examination of lung tissue resected from the vicinity of the bullae showed focal adenocarcinoma, which was masked by re‐expansion pulmonary edema on preoperative computed tomography. Right upper lobectomy with mediastinal lymph node dissection was performed on postoperative day 3.
... Patients typically present soon after inciting event (mins to hrs), or can be delayed for up to 24 -48 hours in some cases, features include acute onset dyspnea, cough, hypoxemia, but may vary from asymptomatic radiologic findings to respiratory failure with circulatory shock. Typical CT findings include ipsilateral GGO's, septal thickening, focal consolidation and areas of atelectasis [8]. Sypmtoms and radiographics abnormalities typically resolve over 24 -48 hours. ...
Article
Full-text available
Reexpansion pulmonary edema (REPE) is a rare and serious complication after sudden expansion of a collapsed lung, usually after intercostal drainage (ICD) tube insertion for massive pleural effusion or tension pneumothorax or therapeutic thoracocentesis. Symptoms include severe persistent cough, with frothy sputum and dyspnea.It can occur immediately or within few hours after ICD insertion. Risk factors include duration of collapse more than 72 hrs, large volume pleural fluid drainage, application of high negative pressure during drainage. Increased permeability of pulmonary capillaries as seen in ARDS (Acute respiratory distress syndrome) is the proposed pathophysiology. We describe a case of REPE in a young female with large left pleural effusion and its successful management.
... However, it can occur anytime within the first 24 hours (16). Radiographically, RPE can present as ipsilateral and less frequently as bilateral ground glass opacities on chest imaging (Figures 4,5) (18). ...
Article
Full-text available
Pleural disease is common and often requires procedural intervention. Given this prevalence, pleural procedures are performed by a wide range of providers with varying skill level in both medical and surgical specialties. Even though the overall complication rate of pleural procedures is low, the proximity to vital organs and blood vessels can lead to serious complications which if left unrecognized can be life threatening. As a result, it is of the utmost importance for the provider to have a firm grasp of the local anatomy both conceptually when preparing for the procedure and physically, via physical exam and the use of a real time imaging modality such as ultrasound, when performing the procedure. With this in mind, anyone who wishes to safely perform pleural procedures should be able to appropriately anticipate, quickly identify, and efficiently manage any potential complication including not only those seen with many procedures such as pain, bleeding, and infection but also those specific to procedures performed in the thorax such as pneumothorax, re-expansional pulmonary edema, and regional organ injury. In this article, we will review the basic approach to most pleural procedures along with essential local anatomy most often encountered during these procedures. This will lay the foundation for the remainder of the article where we will discuss clinical manifestations and management of various pleural procedure complications.
... Appraising the temporal dynamic, the first symptoms often occur within the first hour up to 24 hours after the re-expansion of the lung [7]. As we know from a 22 case series published by Gleeson , who reviewed the CT scans of patients with RPE, the most common CT findings of reexpansion pulmonary edema include ipsilateral ground-glass opacities, septal thickening, foci of consolidation and areas of atelectasis [11]. The aetiology depends on multiple factors; however the pathophysiological process has not yet been completely explored. ...
Article
Full-text available
The reexpansion pulmonary edema is a rare, but life threatening complication of a pneumothorax. Early recognition and a fast symptom orientated therapy are necessary for a good outcome. Several cases after non traumatic pneumothoraces are reported. We describe a patient who presented with a post-traumatic right pneumothorax. After the insertion of a chest tube he developed a reexpansion pulmonary edema, which had to be treated by an intubation. Additionally, a review of the literature regarding case reports of reexpansion pulmonary edema is presented.
Article
Pneumocystis jirovecii pneumonia (PJP) has emerged as a main issue in non Human Immunodeficiency Virus (HIV) immunocompromised hosts, exposing patients to high mortality rates, especially when the diagnosis is delayed. Since microbiological confirmation is often unfeasible or difficult to obtain, High-resolution Computed Tomography (HRCT) represents a main tool for guiding the diagnosis in the appropriate clinical scenario. Nevertheless, radiologists must be aware that PJP at HRCT is a multifaceted process, with a variety of common and less frequent findings, along with a broad spectrum of infectious (e.g., viral and certain fungal and bacterial pneumonias) and non-infectious (e.g., pulmonary oedema, diffuse alveolar haemorrhage, and drug toxicity) differential diagnoses. In this review we resume background clinical information on PJP in non-HIV immunocompromised patients, illustrate both typical and less frequent HRCT findings, and present the spectrum of infectious and non-infectious mimickers at HRCT, highlighting the similarities with PJP and providing clues for the differential diagnosis.
Article
Full-text available
Introduction: In Cuba more than 50% of the coronary surgery is carried out with the beating heart modality. Endotracheal general anesthesia has been the technique used in our service. Neuraxial Anesthesia combined with the general anesthesia method, in this last decade, has prevailed in a certain number of the cardio-vascular centers of the world, due to their undeniable advantages. Objectives: To evaluate the effects of the general anesthesia combined with high thoracic epidural blockade or intra-thecal administration of morphine/ fentanyl on the intraoperative analgesia, time of extubation, intensive care unit and hospital stay. To identify the frequency of appearance of adverse effects related with the spinal administration of opioides and the frequency of appearance of complications related with regional anesthetic's method. Methods: A controlled randomized trial was conducted in patients with diagnosis of coronary heart disease, programmed for off pump coronary artery bypass graft surgery. This patients were assigned to one of the following three groups: Control group (n¼30): Endotracheal general anesthetic method. Multimodal group (n¼29) with thoracic epidural anesthesia: bupivacä a na 0,5% (50 mg) 10 ml/single dose and 5 mg of morphine. Multimodal group with intra-thecal administration of opioides (n¼29): fentanil 1,5 mcg/ kg and morphine 8mcg/kg. Results: The total doses of sistemic fentanyl were smaller in the multimodal groups (2793 micrograms + 2915.94 vs 1300 + 2 392.79 vs 998 + 229.10; p,0.001) The time of extubation (7.83 hours +25.24 vs 4.57 + 2 2.87 vs 1.72+ 2 1.07; p, 0.001) and the intensive care un it stay (CG¼2.83+22.42 days, GMOI¼1.92+ 21.23, GMET¼1.41+20.75, p¼0.005) were smaller too, in both multimodal groups, wihtout differents beetwen then, but this methods didn't influence in the hospital stay. A neurological complication associated to neuraxial blockade was not observed. Conclusions: The multimodal anesthetic methods are more effectives, with they a superior perioperative patients evolution were obtained. Key words: Coronary surgery without extracorporeal circulation, intrathecal opioids, high epidural blockade, spinal anesthesia, epidural anesthesia, multimod-ality anesthesia. References 1 Lena P, Balarac N, Lena D, De la Chapelle A, Arnulf JJ, Mihoubi A, Bonnet F. Fast-track anesthesia with remifentanil and spinal anal-gesia for cardiac surgery: The effect on pain control and quality of recovery. J of cardiothorac and vasc anesthesia 2008; 22(4): 536-42. 2 Yapici D, Ozer ZO, Atici S, Bilgin E, Doruk N, Cinel I, et al. Post-operative effect of low-dose intratecal morphine in coronary artery bypass surgery. J Card Surg 2008; 23: 140-45. 3 Tenenbein PK, Derouwere R, Maguire D, Duke PC, Muirhead B, Enns J, et al. Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery. Can J Anesth 2008; 55(6): 344-50. 4 Caputo M, Alwair H, Roger CA, Ginty M, Monk C, Tomkins S, et al. Myocardial, Inflamtory, and Stress Responses in off-pump coronary artery bypass surgery with thoracic epidural Anesthesia. Ann Thorac Surg 2009; 87: 1119-26. 5 Moraes L, Canavi V, Canavi S, Sa Malbouissan LM, Carvalo CJ. Intrathecal morphine plus general anesthesia in cardiac surgery: Effect on pulmonary funtion, post operative analgesia and plasma morphine concentration. Clinics (Sao Paulo) 2009; 64(4): 279-85.
Conference Paper
Full-text available
Introduction: The concept of preoperative overnight fasting was challenged and prove to have no benefits before surgery, and may involve a more prolonged time (i.e., 16-18h). That has been shown to induce insulin resistance (IR), can be defined as a situation that occurs the biologic response to insulin is reduced compared with the normal situation. Objective: This study aims to analyze the influence of duration of preoperative fasting on insulin resistance and also relates it to the presence of nausea and vomiting after surgery. Methods: Under general anesthesia, 26 patients were selected to undergo elective videolaparoscopic cholecystectomy at the Clinic Hospital of Universidade Federal do Tria ˆngulo Mineiro in Uberaba-MG (UFTM), divided into two groups (G): G1 with 12 patients who stayed more than 12h59min fasting and G2 with 14 patients undergoing lower time than that. Blood samples were collected in three moments (M): M1 immediately before induction of anesthesia, M2 and M3, 6 and 12 hours respectively. Insulin resistance was analyzed using the method Homeostasis Model Assessment-HOMA, and for statistical analysis Mann-Whitney and Chi-Square, p ,00.5, considered statistically significant. Glucose was analyzed in three stages and the presence of nausea and vomiting in M3. Results: the average time of fasting for G1 and G2 were 15h37mim and 11h9mim respectively. The average fasting blood glucose values were higher in M3 for the two groups. Insulin resistance was also increased, reaching maximum values in M3 for both groups. The duration of preoperative fasting did not influence the levels of insulin resistance at M1, M2 or M3, and the same can be said on glycemia, nausea and vomiting. Discussion: In this study there was no relationship between the duration of fasting and insulin resistance. Conclusion: Similarly to the situation in the fasting state, insulin resistance develops after surgery. That has been shown to be related to the magnitude of the surgery performed and fasting. This data does not support adverse affects of prolonged fasting in videolaparoscopic cholecystectomy.
Article
Pulmonary edema is a common condition with numerous causes, some of which are infrequently encountered. This review article describes various uncommon conditions/disease that are associated with pulmonary edema and which show characteristic imaging findings on chest computed tomography or other imaging modality. Thus, this review reflects the variety of factors involved in this frequently encountered condition. We demonstrate the wide range of situations that lead to the development of pulmonary edema by showing the imaging findings of unique cases. These rare varieties of pulmonary edema have distinctive imaging and clinical features that aid in providing an accurate diagnosis.
Article
Full-text available
Bilateral re-expansion pulmonary edema (RPE) is an extremely rare entity. We report the unique case of bilateral RPE following a traumatic, unilateral hemopneumothorax in a young healthy male. Bilateral RPE occurred only one hour after drainage of a unilateral hemopneumothorax. The patient was treated with diuretics and supplemental oxygen. Diagnosis was confirmed by excluding other causes, using laboratory findings, chest radiography, pulmonary and cardiac ultrasound and high resolution computed tomography. His recovery was uneventful. The pathophysiology of bilateral RPE is not well known. Treatment is mainly supportive and consists of diuretics, mechanical ventilation, inotropes and steroids. In case of a pulmonary deterioration after the drainage of a traumatic pneumothorax, bilateral RPE should be considered after exclusion of more common causes of dyspnea.
Article
Full-text available
Clinical details are given of two patients who developed ipsilateral pulmonary oedema following re-expansion of their spontaneous pneumothoraces by intercostal drainage of air. The possible mechanisms underlying the oedema are discussed, and prior literature is analysed. Reference is made particularly to its predictability and to precautions recommended to minimize the frequency of this potentially fatal complication in the management of spontaneous pneumothorax.
Article
Full-text available
Ipsilateral pulmonary edema may occur in a lung that has been rapidly reinflated after a period of collapse. The syndrome of re-expansion pulmonary edema is associated with variable degrees of hypotension and hypoxemia. In its extreme form, it may result in cardiac arrest and death. The initial cause of uninflated pulmonary parenchyma described with re-expansion pulmonary edema has typically been either a large undrained pleural effusion or a pneumothorax. The authors describe a patient in whom re-expansion pulmonary edema developed when inadvertent puncture of large emphysematous bullae released previously atelectatic lung.
Article
We report a case of pneumothorax secondary to emphysema in which we arrested reexpansion pulmonary edema. The patient was a 58-year-old male. A chest drainage tube was inserted to manage the secondary left pneumothorax, but further aggravation of dyspnea and frothy airway secretions were observed shortly after drainage. Because reexpansion pulmonary edema was suspected, we intentionally chose to perform oxygen administration and opening of the drain. As symptoms subsided, the patient was put in a right lateral decubitus, and gradual expansion of the lungs was attempted. As chest X-ray showed suspected edema in the left lung, a potent diuretic was administered. Since no exacerbation of symptoms or decrease in transcutaneous arterial oxygen pressure was noted, the patient was kept under observation without requiring further medication. In a clinical situation where a patient shows aggravation of dyspnea and appearance of frothy sputum during reexpansion of collapsed lungs, it is critical to prevent the development of fatal reexpansion pulmonary edema by arresting rapid expansion of the lungs and avoiding the increase in blood flow into the reexpanding lungs.
Article
Two instances of unilateral pulmonary edema occurring as the result of rapid re-expansion of pneumothorax are described and illustrated. This type of pulmonary edema is preventable by gradual expansion of the lung collapsed by pneumothorax. If edema should occur, however, it resolves in five or six days without permanent sequelae.
Article
A case of pulmonary edema following reexpansion of a collapsed lung due to pneumothorax is described and illustrated. The importance of recognizing this relatively uncommon phenomenon is stressed. The development of such edema can be prevented by avoiding application of sudden and excessive negative pleural pressures during the evacuation of a pneumothorax or a pleural effusion. The edema generally occurs in a lung that has been collapsed for more than three days. The importance of the duration of pulmonary collapse in the causation of edema is demonstrated in this patient.
Article
Twenty-one of 146 cases of spontaneous pneumothorax that were treated by thoracentesis or continuous low negative pressure suction drainage (-12 cm H2O) of the pleural space developed REPE. The rate of REPE was higher in patients 20 to 39 years of age than in those over the age of 40, and the rate progressively increased in proportion to the extent of pneumothorax, as assessed by roentgenographic criteria. It is postulated that age-related changes in the lung may afford some degree of protection against developing REPE. It is also suggested that the treatment of pneumothorax with thoracentesis and/or suction drainage in young patients, or in the face of a large pneumothorax, requires careful consideration in view of a relatively high incidence of REPE in such individuals.
Article
Clinical details are given of two patients who developed ipsilateral pulmonary oedema following re-expansion of their spontaneous pneumothoraces by intercostal drainage of air. The possible mechanisms underlying the oedema are discussed, and prior literature is analysed. Reference is made particularly to its predictability and to precautions recommended to minimize the frequency of this potentially fatal complication in the management of spontaneous pneumothorax.
Article
This article has no abstract; the first 100 words appear below. THE typical "batwing" or "butterfly" pattern of pulmonary edema¹²³ is well known. The relative symmetry of perihilar and basal infiltrates in both lungs is indeed an indicator often used by the radiologist to favor a diagnosis of pulmonary edema as opposed to other possible differential diagnoses (aspiration pneumonia, bacterial pneumonia, etc.). Although it is known that pulmonary edema can sometimes be predominantly unilateral as a result of many possible factors (patient positioning,⁴ congenital heart disease,⁵ pre-existing unilateral lung disease,⁶ etc.), gross asymmetry of involvement in acute pulmonary edema is relatively uncommon. Ipsilateral pulmonary edema has been noted rarely after rapid . . . Source Information From the Leo G. Rigler Center for Radiological Sciences, and the Department of Radiological Sciences, UCLA Center for the Health Sciences (address reprint requests to Dr. Steckel at the Department of Radiological Sciences, UCLA Center for the Health Sciences, Los Angeles, Cal. 90024).
In 52 patients with pleural effusions, pleural pressures were measured initially and serially as pleural fluid was withdrawn. Pleural fluid aspiration was continued until the pleural pressure fell below -20 cmH2O, or the patient developed excessive symptoms, or no more fluid could be obtained. The initial pleural pressure ranged from +8 to -21 cmH2O. The rate of pleural pressure change as fluid was withdrawn was highly variable. In 13 of 52 procedures (25%), thoracentesis was terminated because the pressure fell below -20 cmH2O. Negative initial pleural pressures and/or rapid changes in the pressures as fluid was withdrawn were suggestive of malignancy or trapped lung. The measurement of pleural pressures in patients with pleural effusions may be useful diagnostically. More importantly, because large changes in pleural pressures are not readily detectable by the operator, pleural pressures should be monitored when large amounts (> 1,000 ml) of pleural fluid are removed to increase the safety of the procedure.
Article
Re-expansion pulmonary oedema is a recognised but rare complication following the rapid drainage of a large pleural effusion or pneumothorax [1,2], usually occurring on the side of re-inflation. The pathogenesis of the pulmonary oedema is poorly understood but is thought to be due to micro-vascular shearing resulting in neutrophil activation and adhesion to the vascular endothelium resulting in increased micro-vascular permeability [3-7]. Few reports appear in the literature of invasive haemodynamic monitoring following this catastrophe. We describe a patient who sustained fatal pulmonary oedema arising in the contralateral lung, with pulmonary flow catheter data documenting the initial circulatory collapse following the aspiration of a massive pulmonary effusion.
Article
Reexpansion pulmonary edema is a rare complication attending the rapid reexpansion of a chronically collapsed lung, such as occurs after evacuation of a large amount of air or fluid from the pleural space. The condition usually appears unexpectedly and dramatically-immediately or within 1 h in 64% of patients and within 24 h in the remainder. The clinical manifestations are varied; they range from roentgenographic findings alone in asymptomatic patients to severe cardiorespiratory insufficiency. The radiographic evidence of reexpansion pulmonary edema is a unilateral alveolar filling pattern, seen within a few hours of reexpansion of the lung. The edema may progress for 24-48 h and persist for 4-5 days. Human data on the pathophysiology of reexpansion pulmonary edema derive from small series of patients, case reports, and reviews of the literature. On the other hand, a larger body of data exists on experimental reexpansion pulmonary edema in cats, monkeys, rabbits, sheep, and goats. This review examines the clinical and experimental evidence for reexpansion pulmonary edema. In addition, we detail the historical background, clinical setting, treatment, and outcome of reexpansion pulmonary edema.
Article
The purposes of this study were to review possible causes of reexpansion pulmonary edema (RPE) and to attempt to explain atypical distributions of RPE after drainage of large pleural effusions. Five patients had focal RPE after routine drainage of large pleural effusions. In these cases, pleural effusion did not completely fill the hemithorax, and part or all of the ipsilateral upper lobe remained aerated. Reexpansion was accomplished by chest tube drainage with -20 cm H2O suction in four cases and by percutaneous needle aspiration without application of negative intrapleural suction in one. In all five cases, RPE developed in the portion of the lung that had been collapsed but did not develop in the portion of the lung that remained aerated. This suggests that hypoxic injury to the atelectatic lung, rather than mechanical stress, is the most plausible explanation for RPE.
Article
The objectives of this study are as follows: (1) to determine the incidence of complications from thoracentesis performed under ultrasound guidance by interventional radiologists in a tertiary referral teaching hospital; (2) to evaluate the incidence of vasovagal events without the use of atropine prior to thoracentesis; and (3) to evaluate patient or radiographic factors that may contribute to, or be predictive of, the development of re-expansion pulmonary edema after ultrasound-guided thoracentesis. Prospective descriptive study. Saint Thomas Hospital, a tertiary referral teaching hospital in Nashville, TN. All patients referred to interventional radiology for diagnostic and/or therapeutic ultrasound-guided thoracentesis between August 1997 and September 2000. A total of 941 thoracenteses in 605 patients were performed during the study period. The following complications were recorded: pain (n = 25; 2.7%), pneumothorax (n = 24; 2.5%), shortness of breath (n = 9; 1.0%), cough (n = 8; 0.8%), vasovagal reaction (n = 6; 0.6%), bleeding (n = 2; 0.2%), hematoma (n = 2; 0.2%), and re-expansion pulmonary edema (n = 2; 0.2%). Eight patients with pneumothorax received tube thoracostomies (0.8%). When > 1,100 mL of fluid were removed, the incidence of pneumothorax requiring tube thoracostomy and pain was increased (p < 0.05). Fifty-seven percent of patients with shortness of breath during the procedure were noted to have pneumothorax on postprocedure radiographs, while 16% of patients with pain were noted to have pneumothorax on postprocedure radiographs. Vasovagal reactions occurred in 0.6% despite no administration of prophylactic atropine. Re-expansion pulmonary edema complicated 2 of 373 thoracenteses (0.5%) in which > 1,000 mL of pleural fluid were removed. The complication rate with thoracentesis performed by interventional radiologists under ultrasound guidance is lower than that reported for non-image-guided thoracentesis. Premedication with atropine is unnecessary given the low incidence of vasovagal reactions. Re-expansion pulmonary edema is uncommon even when > 1,000 mL of pleural fluid are removed, as long as the procedure is stopped when symptoms develop.
Article
To avoid reexpansion pulmonary edema (RPE), thoracenteses are often limited to draining no more than 1 L. There are, however, significant clinical benefits to removing more than 1 L of fluid. The purpose of this study was to define the incidence of RPE among patients undergoing large-volume (> or = 1 L) thoracentesis. One hundred eighty-five patients undergoing large-volume thoracentesis were included in this study. The volume of fluid removed, absolute pleural pressure, pleural elastance, and symptoms during thoracentesis were compared in patients who did and did not experience RPE. Of the 185 patients, 98 (53%) had between 1 L and 1.5 L withdrawn, 40 (22%) had between 1.5 L and 2 L withdrawn, 38 (20%) had between 2 L and 3 L withdrawn, and 9 (5%) had more than 3 L withdrawn. Only 1 patient (0.5%, 95% confidence interval: 0.01% to 3%) experienced clinical RPE. Four patients (2.2%, 95% confidence interval: 0.06% to 5.4%) had radiographic RPE (diagnosed only on postprocedure imaging without clinical symptoms). The incidence of RPE was not associated with the absolute change in pleural pressure, pleural elastance, or symptoms during thoracentesis. Clinical and radiographic RPE after large-volume thoracentesis is rare and independent of the volume of fluid removed, pleural pressures, and pleural elastance. The recommendation to terminate thoracentesis after removing 1 L of fluid needs to be reconsidered: large effusions can, and should, be drained completely as long as chest discomfort or end-expiratory pleural pressure less than -20 cm H2O does not develop.