Rarely fatal bilateral re-expansion pulmonary edema after inserting a chest tube for unilateral spontaneous pneumothorax
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CASE REPORT
Rarely fatal bilateral re‑expansion pulmonary edema after inserting a chest tube for unilateral spontaneous pneumothorax: a case report Dong Qu1,2 · Na Chen3 · Dong‑Fang Qiao1 · Hui‑Jun Wang1 · Xiao‑Hui Tan1 Accepted: 8 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We describe a case of a 32-year-old man who died due to bilateral re-expansion pulmonary edema (RPE) following the insertion a chest tube for unilateral spontaneous pneumothorax. Fifteen minutes after inserting the chest tube, the patient with right spontaneous pneumothorax was diagnosed with right re-expansion edema by chest radiograph. Although multiple treatments were administered, the patient died. However, the findings from autopsy showed bilateral RPE existed in the decedent but not unilateral RPE. Autopsy, microscopic examination, and clinical records concluded that the cause of death was acute cardiac and respiratory failure due to bilateral re-expansion pulmonary edema following unilateral spontaneous pneumothorax. Bilateral RPE due to a unilateral pneumothorax is quite rare in clinical and forensic practice. To the best of our knowledge, this is the first time that the pathological changes of RPE have been described by gross and microscopic examinations. This case is reported to provide histopathologic references for diagnosis of RPE and indicate that combining death investigation, pathological findings and clinical courses plays a vital role in diagnosis of RPE in forensic pathology. Keywords Re-expansion pulmonary edema · Spontaneous pneumothorax · Chest tube · Forensic pathology · Histopathology
Introduction Re-expansion pulmonary edema (RPE) is an acute, rare and potentially life-threatening complication of needle aspiration or chest tube drainage [1]. The incidence of RPE varies from 0.9–14.4% [2]. The mortality rate of RPE is approximately 20% [3, 4]. RPE, as a complication of spontaneous pneumothorax, was first put forward by Carlson in 1958 [5]. The clinical presentation of RPE is characterized by a rapid onset of dyspnea and tachypnea within 1 h of the re-expansion of the collapsed lung [3]. RPE often occurs in the affected lung area. The majority of RPE patients receiving supportive * Hui‑Jun Wang [email protected] * Xiao‑Hui Tan [email protected] 1
Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, Guangzhou, China
2
Institute of Legal Medicine, Hannover Medical School, Hannover, Germany
3
Department of Pathology, Guangdong Women and Children Hospital, Guangzhou, China
treatments get well within 24–48 h after onset of RPE [1, 6]. We report a rare occurrence of fatal bilateral re expansion pulmonary edema following unilateral pneumothorax in a young man.
Case report A 32-year-old male patient came to the hospital in the morning, complaining of chest pain, shortness of breath in the right side of the chest, and a cough with a 20-day history. The patient had no smoking history. There were no respiratory sounds in the righ
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