Clinical Images  |   January 2020
Reexpansion Pulmonary Edema
Author Notes
  • From the Emergency Medicine Residency Program at Spectrum Health Lakeland in Saint Joseph, Michigan. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Kristen Whitworth, DO, 2103 Langley Ave, Saint Joseph, MI 49085. Email:
Article Information
Imaging / Pulmonary Disorders / Clinical Images
Clinical Images   |   January 2020
Reexpansion Pulmonary Edema
The Journal of the American Osteopathic Association, January 2020, Vol. 120, 49. doi:
The Journal of the American Osteopathic Association, January 2020, Vol. 120, 49. doi:
A 34-year-old woman with no significant medical history presented to the emergency department with an outpatient anteroposterior chest radiograph demonstrating a large right-sided pneumothorax. She had chest pain and shortness of breath for 9 days after power washing her deck. Reexpansion of the lung failed with thoracostomy and placement of a 10.2 F tube (image A), but was successful after placement of a 28 F tube. Subsequently, the patient became hypoxic, requiring supplemental oxygen via nonrebreather mask. Repeated chest x-ray imaging revealed increased alveolar opacification of the right lung consistent with pulmonary edema (image B). The patient was admitted to the intensive care unit and remained stable with 30 L/minute high-flow nasal cannula for 2 days before the chest tube was removed. 
Reexpansion pulmonary edema (RPE) is a rare complication following pleural fluid drainage or pneumothorax reexpansion, with a rate of occurrence from 0.9% to 14.4%.1,2 Several factors are thought to contribute to development, including increased capillary permeability, reperfusion injury, depletion of alveolar surfactant, and alteration in hydrostatic forces.2 The condition usually appears unexpectedly and dramatically within 1 hour in 64% of patients and within 24 hours in the remainder.3 Clinical manifestations range from roentgenographic findings in asymptomatic patients to severe cardiorespiratory insufficiency, with a mortality rate up to 20%.1,3 The radiographic evidence of RPE is a unilateral alveolar filling pattern.1 Treatment options are supportive but may include positive pressure ventilation.4 
Gleeson T, Thiessen R, Müller N. Reexpansion pulmonary edema: computed tomography findings in 22 patients. J Thorac Imaging. 2011;26(1):36-41. doi: 10.1097/RTI.0b013e3181ced052 [CrossRef] [PubMed]
Baik JH, Ahn MI, Park YH, Park SH. High-resolution CT findings of re-expansion pulmonary edema. Korean J Radiol. 2010;11(2):164-168. doi: 10.3348/kjr.2010.11.2.164 [CrossRef] [PubMed]
Sherman SC. Reexpansion pulmonary edema: a case report and review of the current literature. J Emerg Med. 2003;24(1):23-27. [CrossRef] [PubMed]
Verhagen M, van Buijtenen JM, Geeraedts LMJr. Reexpansion pulmonary edema after chest drainage for pneumothorax: a case report and literature overview. Respir Med Case Rep. 2014;14:10-12. [PubMed]