Abstract
In a previous study on the risk of reexpansion pulmonary edema (RPE) after large-volume thoracentesis, Feller-Kopman and colleagues [1Feller-Kopman D. Berkowitz D. Boiselle P. Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema.Ann Thorac Surg. 2007; 84: 1656-1661Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar] reported that clinical RPE developed in 1 of the 185 patients (0.5%) who underwent large-volume thoracentesis (≥1 L). The incidence of RPE was not associated with the volume of fluid removed, pleural pressure, or pleural elastance. They suggested that more than 1 L of pleural fluid can be drained at 1 session. However, we encountered a case of severe RPE after large-volume thoracentesis in December 2010. A 60-year-old man having hypertension, diabetes mellitus, and hepatitis B virus-related liver cirrhosis experienced shortness of breath for 5 days. Left-sided pleural effusion was noted (Fig 1). Ultrasound-guided thoracentesis was performed, and 1,120 mL of pleural fluid was removed without using negative suction pressure. He did not experience chest discomfort during the procedure but developed pulmonary edema with respiratory failure, shock, and unconsciousness after 2 hours (Fig 2). He was resuscitated and discharged 2 weeks later without any sequelae.Fig 2Chest roentgenogram acquired 2 hours after large-volume thoracentesis showing pulmonary edema.View Large Image Figure ViewerDownload (PPT) The amount of pleural fluid that can be removed at 1 session has been a subject of debate because of the risk of RPE [1Feller-Kopman D. Berkowitz D. Boiselle P. Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema.Ann Thorac Surg. 2007; 84: 1656-1661Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar, 2Light R.W. Thoracentesis (diagnostic and therapeutic) and pleural biopsy.in: Light R.W. Pleural diseases. 4th ed. Lippincott Williams & Wilkins, Philadelphia2001: 365-371Google Scholar, 3Havelock T. Teoh R. Laws D. Gleeson F. BTS Pleural Disease Guideline GroupPleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010.Thorax. 2010; 65: ii61-ii76Crossref PubMed Scopus (445) Google Scholar]. We believe that large-volume thoracentesis can be performed if it is clinically indicated. The incidence of RPE after large-volume thoracentesis is low (<1%) [1Feller-Kopman D. Berkowitz D. Boiselle P. Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema.Ann Thorac Surg. 2007; 84: 1656-1661Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar, 4Jones P.W. Moyers J.P. Rogers J.T. Rodriguez R.M. Lee Y.C. Light R.W. Ultrasound-guided thoracentesis: Is it a safer method?.Chest. 2003; 123: 418-423Crossref PubMed Scopus (233) Google Scholar]. However, the mortality rate in such patients may be as high as 20% [5Mahfood S. Hix W.R. Aaron B.L. Blaes P. Watson D.C. Reexpansion pulmonary edema.Ann Thorac Surg. 1988; 45: 340-345Abstract Full Text PDF PubMed Scopus (264) Google Scholar]. We have reported our case to remind others of this rare but possibly fatal complication. The risks and benefits of large-volume thoracentesis should be further investigated.
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