Case: 32 year old lean thin man presented to ED with 4 days of "Right" sided chest pain associated with shortness of breath. CXR showed sponteneous pneumothorax (PTX) on "Right" side. Chest tube is inserted with immediate resolution of PTX. 2 hours later patient complaint of shortness of breath again. Physical exam shows crackles on "Left " side?


Answer: "Contralateral" Reexpansion Pulmonary Edema

Reexpansion pulmonary edema (REPE) is a rare but known complication of evacuation of pleural effusion or pneumothorax. Usually it occurs on same side or both side but it may occur only in contralateral lung. Mechanism for this phenomenon is not known.

Risk for REPE is high if lung is collapsed for more than 3 days. If its secondary to pleural effusion it is recommended to remove no more than 1 liter of fluid. The treatment is supportive with supplemental oxygen, positive pressure ventilation, and diuresis.