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The incidence of re-expansion pulmonary edema (REPE) is 0.2-14% of thoracentesis (1). Mortality is up to 20% (2). Symptoms include:

The onset of symptoms is within 24 hours and 64% of patients have the onset of symptoms within 1-2 hours (1-3). Symptoms usually resolve within 24-72 hours.

The pathophysiology of REPE is poorly understood and likely multifactorial (2). One promising theory is that ventilation and reperfusion injury of a previously collapsed lung leads to production of reactive oxygen species and superoxide radicals resulting in increased capillary permeability.

Risk of REPE is thought to be minimal if pleural pressure is maintained above -20 cm H2O throughout the thoracentesis (4).  Others have advocated limiting drainage to about 1-1.5L of pleural fluid to avoid REPE (1).

Treatment is largely supportive and includes supplemental oxygen for hypoxemia (1-3). Use of diuretics, bronchodilators, prostaglandin analogues, ibuprofen and steroids remains largely anecdotal (1).

References

  1. Kasmani R, Irani F, Okoli K, Mahajan V. Re-expansion pulmonary edema following thoracentesis. CMAJ. 2010;182(18):2000-2. [CrossRef] [PubMed] 
  2. Mahfood S, Hix WR, Aaron BL, Blaes P, Watson DC. Reexpansion pulmonary edema. Ann Thorac Surg. 1988;45(3):340-5. [CrossRef]  [PubMed]
  3. Feller-Kopman D, Berkowitz D, Boiselle P, Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg. 2007;84(5):1656-61. [CrossRef] [PubMed]
  4. Light RW, Jenkinson SG, Minh VD, George RB. Observations on pleural fluid pressures as fluid is withdrawn during thoracentesis. Am Rev Respir Dis 1980; 121:799–804. [PubMed] 

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