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J Thorac Cardiovasc Surg 2002;123:387-389
© 2002 The American Association for Thoracic Surgery

Brief Communications

Analysis of edema fluids and histologic features of the lung in reexpansion pulmonary edema during video-assisted thoracoscopic surgery

From the Department of Surgery, Sendai Kosei Hospital,^a and the Department of Pathology, School of Medicine, Tohoku University,^b Sendai, Japan.

Received for publication July 19, 2001. Accepted for publication Aug 31, 2001. Address for reprints: Satoshi Suzuki, MD, Department of Surgery, Sendai Kosei Hospital, 4-15, Hirose-machi, Aoba-ku, Sendai, Japan 980-0873 (E-mail: shpakira@yahoo.co.jp).

Reexpansion pulmonary edema (PE) is a rare complication of general thoracic surgery; however, it may lead to severe hypoxemia with a mortality as high as 20%. ¹ The exact mechanisms of development and resolution of reexpansion PE remain undefined. We present here 2 cases of reexpansion PE in which edema fluids drained from endobronchial tubes during video-assisted thoracic surgery (VATS) for pneumothoraces. We examined edema fluids and histologic characteristics of the lung and provide evidence of acute inflammatory response and active Na⁺ transport in the process of rapid development and resolution of reexpansion PE.

Clinical summary
Patient 1
A 52-year-old man had shortness of breath for 10 days. The chest x-ray film showed a collapsed left lung with a giant bulla. The left upper lobe remained completely collapsed after overnight chest drainage. A double-lumen endobronchial tube was inserted, and both lungs were ventilated at a maximal airway pressure of 20 cm H₂O. Approximately 1 hour after the start of mechanical ventilation, yellowish and clear fluid drained from the left lung over 30 minutes (20 mL in total). Pulse oximetry was consistently at 100% with the patient breathing 50% oxygen. Once the . . . [Full Text of this Article]

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