Massive unilateral pulmonary oedema as a rapid re-expansion sequel (the post-expansion syndrome). Report of a case and review of the literature.

Abstract

The unusual complication of unilateral pulmonary oedema following closed thoracotomy drainage for massive spontaneous pneumothorax, which is presented in this communication, occurred in a patient suffering from advanced pulmonary emphysema. The physiopathology of the “Post-expansion syndrome” is discussed and the literature reviewed.Restoration of cardio-respiratory physiology following development of pneumothorax, can be accomplished by closed thoracotomy drainage, a simple and safe procedure leading to air-leakage sealing and subsequently to complete re-expansion of the collapsed lung. However, in spite of the simplicity of the method and its widespread clinical acceptance, such a procedure may be followed by fatal complications in connection with sudden lung expansion and coincide with rapid removal of air into a vacuum system of closed drainage. We became interested in this remarkable pathological condition two years ago when we first encountered a case of 100% spontaneous pneumothorax, in which closed thoracotomy drainage was followed by massive pulmonary oedema on the involved side, leading shortly thereafter to death.