Abstract
Symptomatic pleural effusions are a common reason for hospital visits. Guidelines recommend draining < 1.5 L with large-volume thoracentesis (LVT) to avoid re-expansion pulmonary edema (REPE). Hemithorax opacification by pleural fluid on chest X-ray (CXR) has not been studied as predictor of REPE. We evaluated the incidence of REPE using hemithorax opacification on CXR.
Highlights
Symptomatic pleural effusions are a common reason for hospital visits
Median volume drained was 1.8 L (IQR 1.6 L-2.0 L) and median percent opacification drained was 26% (IQR 13-40%): 11.1% of cases drained > 50% opacification, and 17.7% had complete drainage. 177 post-procedural chest X-ray (CXR) were amenable for evaluation and 20.3% had evidence of radiographic re-expansion pulmonary edema (REPE)
Multivariate regression analysis demonstrated that draining > 50% of the opacified hemithorax was associated with radiographic REPE and clinical REPE
Summary
Guidelines recommend draining < 1.5 L with large-volume thoracentesis (LVT) to avoid re-expansion pulmonary edema (REPE). Hemithorax opacification by pleural fluid on chest X-ray (CXR) has not been studied as predictor of REPE. We evaluated the incidence of REPE using hemithorax opacification on CXR. Symptomatic large pleural effusions are frequent among patients presenting to the emergency department, often necessitating inpatient admission. Re-expansion pulmonary edema (REPE) is a welldescribed but uncommon complication seen following expansion of a compressed lung after a large amount of pleural fluid is rapidly evacuated [2,3]. It is hypothesized that REPE develops after a rapid change in transpleural pressure with subsequent engorgement of Citation: Prado VE, Chen SX, Basu A, Wakefield CJ, Sukhal S, et al (2021) Hemithorax Opacification & Large Volume Thoracentesis: A Novel Predictor of Re-Expansion Pulmonary Edema. Clinical REPE occurs after < 1% of thoracentesis, the mortality rate has been reported as high as 20% [7,8,9]
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