Question

Re-expansion pulmonary edema.

Hint:

In cases of pleural effusion or pneumothorax, careful monitoring is required during lung re-expansion to prevent re-expansion pulmonary edema.

Answer 1

Step 1: Understanding Re-expansion Pulmonary Edema.
Re-expansion pulmonary edema (RPE) refers to the rapid development of pulmonary edema following the re-expansion of a collapsed lung. This is commonly seen after the removal of a large pleural effusion or the re-expansion of a lung that had been collapsed due to a pneumothorax or other conditions.

Step 2: Mechanism of RPE.
When a collapsed lung is rapidly re-expanded, the sudden increase in lung volume leads to an increased stress on the alveolar-capillary membrane. This results in increased capillary permeability and fluid leakage into the alveoli, causing pulmonary edema. The exact mechanism is not fully understood, but it is thought to be related to the rapid re-expansion disrupting the normal balance of pressures in the lung.

Step 3: Risk Factors.
Risk factors for RPE include the rapid re-expansion of the lung, large volumes of pleural fluid removed, and the underlying cause of the lung collapse, such as severe pneumothorax or pleural effusion. The use of mechanical ventilation after re-expansion can also increase the risk of RPE.

Step 4: Diagnosis and Management.
Diagnosis of RPE is based on clinical presentation (acute respiratory distress after lung re-expansion) and imaging studies (e.g., chest X-ray showing bilateral alveolar infiltrates). Management focuses on supportive care, including oxygen therapy and mechanical ventilation if necessary. In severe cases, diuretics may be used to reduce pulmonary edema.