Chest
Fatal Pulmonary Edema and Pneumonitis After Reexpansion of Chronic Pneumothorax
Section snippets
TECHNIQUE
Our standard technique consists of introducing a trocar through the second intercostal space of the affected pleural cavity and inserting an 18-French rubber catheter through the trocar. Suction is applied to the catheter during its insertion to produce rapid reexpansion of the lung and, in so doing, carries the catheter to the apex of the pleural space, the most desirable position. Then suction of about 20 to 25 cm of water is maintained to the intercostal tube.
CASE REPORT
A 69-year-old man suffered spontaneous pneumothorax June 13, 1969. Initial treatment was expectant, but reexpansion did not occur. The patient entered his local hospital for a short time, during which period 500 ml of air was aspirated from the right pleural space. Improvement was brief, but progressive shortness of breath prompted referral to us and admission to St. Joseph's Hospital, Marshfield, Wisconsin on September 3, 1969, 81 days after the initial event.
The patient's medical history
AUTOPSY
The principal pathologic changes were found in the lungs. The right weighed 800 gm and showed pronounced edema, more in the lower than in the upper lobes. The bronchial system contained frothy material. A 3-cm bleb at the apex of the upper lobe undoubtedly accounted for the pneumothorax. The left lung was somewhat congested but weighed only 450 gm. Thrombi and emboli were absent from the arterial and venous systems of both lungs.
Microscopically, the right lung revealed severe acute passive
DISCUSSION
Ziskind1 reported a similar but not fatal case in 1965. He postulated that the high negative pressure in the intrapleural space accounted for the pulmonary edema which was thought to be bilateral on a clinical basis, but was radiographically unilateral. A similar mechanism was ascribed to the use, in the distant past, of the Potain apparatus for the aspiration of pleural fluid, although, with this apparatus, bilateral pulmonary edema was not uncommon.
These explanations are not completely
REFERENCES (2)
- et al.
Unilateral pulmonary oedema after pleural aspiration
Lancet
(1970) - et al.
Acute pulmonary edema following the treatment of spontaneous pneumothorax with excessive negative intrapleural pressure
Amer Rev Resp Dis
(1965)
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