CASE 133

AP chest radiograph (Fig. 133.1A) reveals a right-sided tension pneumothorax, marked leftward mediastinal shift, and left lower lobe volume loss. AP chest radiograph 24 hours later (Fig. 133.1B) immediately following chest tube placement shows relief of the pneumothorax. However, right perihilar, upper lobe, and lower lobe air space consolidations are now present. AP chest radiograph 10 hours following the chest tube placement (Fig. 133.1C) shows progressive right perihilar air space consolidation, air bronchograms, ipsilateral lower lobe volume loss, and a right pleural effusion.

Diagnosis

Re-expansion pulmonary edema (RxPE) is a mixed form of edema (see discussion in Case 131) resulting from a simultaneous increase in hydrostatic pressure and some degree of diffuse alveolar damage with permeability changes. This rare form of acute lung injury usually follows rapid reinflation of collapsed lung parenchyma, with an incidence of up to 1% following evacuation of pleural air or fluid. In most cases, the affected lung has been collapsed for three or more days. RxPE may also be related to the volume of the intrathoracic space occupied by fluid, air, or mass; the presence of bronchial obstruction; the application of excessive suction to the tracheobronchial tree during bronchoscopy and suctioning with a tracheal catheter; alterations of pulmonary artery pressure; and the removal of large extrathoracic lesions (i.e., abdominal masses) that may have compressed the thoracic cavity.

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