Introduction The Reexpansion Pulmonary Edema (RPE) is a rare condition, lethal in 20%, resulting after a fast drainage of pleural effusion, pneumothorax or a huge mediastinal mass. We report a case of RPE after treatment for pleural effusion. Beside typical symptoms as hyponatremia, hyperkalaemia, hyperglycaemia, an interesting finding was a high haematocrit value (>65%), never described. We want to stress the importance of early recognition of signs and symptoms: inadequate or delayed treatment may lead to a fatal outcome. Methods After two months from a cardiac revascularization, a 68-year-old male patient was re-admitted for respiratory failure (SpO2 Results The pulmonary edema diminished gradually and the patient was extubated after one day: the haematocrit was 42%. The radiography showed a reduction of edema (Fig.1C). At third day, the patient was discharged to the ward. Discussion Recently Meeker1 defined RPE “an uncommon complication of a common clinical scenario” with an unclear pathophysiology. Age, clinical status, rapid thoracentesis or chest drainage are important risk factors for this rare iatrogenic complication. Literature shows a removing volume of 1200-1800 ml as a safe cut-off. This process, resulting in local and systemic factors, starts with an acute lung reexpansion and consequently insurgence of pulmonary edema, related to the hydrostatic forces on pulmonary capillaries: the return of high perfusion pressure after rapid thoracentesis or chest drainage is associated with negative pressure and vessel hypoxic constriction. This reperfusion increases free oxygen radicals and anoxic stress resulted in the production of cytokines by the endothelium: selectin, TNF-a and IL-1b, generating increased protein permeability. We assume that the drop in osmotic pressure causes the leakage of liquids into the extracellular space leading to a rapid increase in the hematocrit value associated to hyponatremia: these early alerts can help the staff to avoid a rapidly worsening of respiratory function and to start a correct treatment.
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