REPO - re-expansion Pulmonary Oedema



Background

  • Re-expanding a collapsed lung may result in re-expansion pulmonary oedema(REPO).
  • May occur in 1% of cases after draining air, blood or fluid.
  • More common if large volume (air or fluid) drained rapidly or collection present for some time before drainage.
  • Re-perfusion of locally hypoxic lung leads to inflammatory response and ↑ local capillary permeability.

Clinical

Within 2 hours of thoracocentesis:

  • Asymptomatic radiological changes or
  • Cough / SOB or
  • Frank pulmonary oedema with hypoxia
  • Frothy pink (rather than purulent) sputum

Differential Dx

  • Infection of the re-expanded lung

nvestigations

  • CXR confirms unilateral airspace opacification of the re-expanded lung.

Management

  • Controlled drainage of large pleural effusions by clamping the drain if more than 1.5 L of fluid is drained in the first hour after insertion, or if the patient develops a cough.
  • Do NOT clamp if draining a pneumothorax.
  • Treat with oxygen, analgesia, diuretics, CPAP / NIV.
  • Role of diuretics is controversial.
Left PTX, Thank you BMJ for educational image CXR post intercostal drain - thank you BMJ for educational image

Content By Dr. Íomhar O' Sullivan date. Last review Dr. ÍOS 9/09/14.