FOCAL REEXPANSION PULMONARY-EDEMA AFTER DRAINAGE OF LARGE PLEURAL EFFUSIONS - CLINICAL-EVIDENCE SUGGESTING-HYPOXIC INJURY TO THE LUNG AS THE CAUSE OF EDEMA

Background. The purposes of this study were to review possible causes of reexpansion pulmonary edema (RPE) and to attempt to explain atypica l distributions of RPE after drainage of large pleural effusions. Meth ods. Five patients had focal RPE after routine drainage of large pleur al effusions. In these cases, pleural effusion did not completely fill the hemithorax, and part of all of the ipsilateral upper lobe remaine d aerated. Reexpansion was accomplished by chest tube drainage with -2 0 cm H2O suction in four cases and by percutaneous needle aspiration w ithout application of negative intrapleural suction in one. Results. I n all five cases, RPE developed in the portion of the lung that had be en collapsed but did not develop in the portion of the lung that remai ned aerated. Conclusions. This suggests that hypoxic injury to the ate lectatic lung, rather than mechanic stress, is the most plausible expl anation for RPE.