REPO - re-expansion Pulmonary Oedema


  • 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


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


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


  • 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 02/05/2016. Last review Dr ÍOS 18/06/21.