The
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Reexpansion Pulmonary Edema after Thoracentesis A
B
C
A
67-year-old-man with advanced alcoholic cirrhosis presented Giovanni Perricone, M.D. with progressive dyspnea. Chest radiography showed findings suggestive Chiara Mazzarelli, M.D. of a large right pleural effusion (Panel A). Since hepatic hydrothorax was A.O. Ospedale Niguarda Ca’ Granda suspected, thoracentesis was performed, resulting in the aspiration of 1500 ml of Milan, Italy transudative fluid. Four hours later, the patient started coughing and had tachyp- [email protected] nea and tachycardia, with right lung crackles heard on physical examination. The oxygen saturation was 82% while he was breathing ambient air. Computed tomography (CT) of the chest showed diffuse areas of consolidation and ground-glass opacity in the right lung (Panel B, arrows), suggestive of reexpansion pulmonary edema. After the patient received diuretics and high-flow oxygen through a reservoir mask, there was progressive improvement in his condition. After 4 days, a complete resolution of radiologic findings was seen on CT (Panel C). Reexpansion pulmonary edema can be a complication of thoracentesis. Treatment is largely supportive. Risk factors for this condition include a young age, a long duration of lung collapse, and rapid reexpansion. DOI: 10.1056/NEJMicm1309844 Copyright © 2014 Massachusetts Medical Society.
n engl j med 370;12
nejm.org
march 20, 2014
The New England Journal of Medicine Downloaded from nejm.org on October 18, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
e19
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Reexpansion Pulmonary Edema after Thoracentesis A
B
C
A
67-year-old-man with advanced alcoholic cirrhosis presented Giovanni Perricone, M.D. with progressive dyspnea. Chest radiography showed findings suggestive Chiara Mazzarelli, M.D. of a large right pleural effusion (Panel A). Since hepatic hydrothorax was A.O. Ospedale Niguarda Ca’ Granda suspected, thoracentesis was performed, resulting in the aspiration of 1500 ml of Milan, Italy transudative fluid. Four hours later, the patient started coughing and had tachyp- [email protected] nea and tachycardia, with right lung crackles heard on physical examination. The oxygen saturation was 82% while he was breathing ambient air. Computed tomography (CT) of the chest showed diffuse areas of consolidation and ground-glass opacity in the right lung (Panel B, arrows), suggestive of reexpansion pulmonary edema. After the patient received diuretics and high-flow oxygen through a reservoir mask, there was progressive improvement in his condition. After 4 days, a complete resolution of radiologic findings was seen on CT (Panel C). Reexpansion pulmonary edema can be a complication of thoracentesis. Treatment is largely supportive. Risk factors for this condition include a young age, a long duration of lung collapse, and rapid reexpansion. DOI: 10.1056/NEJMicm1309844 Copyright © 2014 Massachusetts Medical Society.
n engl j med 370;12
nejm.org
march 20, 2014
The New England Journal of Medicine Downloaded from nejm.org on October 18, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
e19
