Authors
Dr. Mahajan GN, DNB Residenta, Dr. Sangeetha E, Junior Consultanta, Dr. CP Rauf, Chiefa. aDepartment of Respiratory Medicine, Chest Hospital, Calicut.
Abstract
CASE
A 48 yrs old male came with history of breathlessness and right sided chest pain of 15 days duration. The breathlessness was on exertion without wheeze, palpitation. Chest pain was dull aching in quatity and patient was unable to walk few metres without becoming breathless . There is no history of pulmonary tuberculosis. He is non-diabetic, non- hypertensive. He is an ex- beedi smoker with 10 pack-yr. history of smoking. He stopped smoking 3 yrs back. He consulted a general practioner who diagnosed that he has pneumothorax on the right following chest X- ray and he was observed for 1 week. As the pneumothorax, was not improving, the patient was referred to our care. (Date : 1/9/07)
On examination, patient was in no appearent distress and he was afebrile, pulse 110/min regular, respiratory rate 30/min. BP 130/80 mmHg. O2 sat : 95% in room air, no pallor, cyanosis, clubbing, icterus, lymphadenopathy or pedal oedema. JVP was normal. On respiratory system examination, Trachea was central, apex beat in left 5th intercostal space in mid-clavicular line. Respiratory movements were diminished on right side, Vocal fremitus diminished, percussion note hyper-resonant, breath sounds were diminished in the right infrascapular, mammary, axillary areas. Other systems normal.
X ray chest postero-anterior view was done (9.42 p.m.) which showed right pneumothorax. Tube thoracostomy was done (10.10 p.m.) in right mid- axillary line in 5th intercostal space. Following tube thoracostomy, initially. O2 sat (10.20 p.m.) improved to 98 % but later patient developed mild cough and saturation dropped to 92 % (time 10.30 pm) and his pulse became low volume BP 80/60 skin cold and clammy.
Patient was shifted to ICU, O2 inhalation, nebulizer bronchodilators and normal saline infusion given. No diuretic used. On auscultation now there were fine crepititions in the expanded lung. Diagnosis of re- expansion pulmonary oedema was made (10.45 pm). Post procedure Xray done ; which showed extensive consolidation right lung. (11.00 p.m.) Diagnosis of re-expansion pulmonary oedema confirmed, patient was treated with bronchodilator, intravenous fluids non invasive ventilation. Patient improved by 12.00 mid-night with saturation 97 % and by 2.00 a.m. saturation was 99 % with oxygen 2 liter/min.. Later hospital stay was uneventful and intercostal tube was removed four days later and patient was discharged.
Re-expansion pulmonary oedema is a rare entity, reported incidence being 0.9 % after drainage of pneumothorax or pleural ef- fusion. Though easily recognizable clinically and radiologically, and not difficult to treat, the mortality may occur even in previously healthy young individual. Here we are reporting a case of re-expansion pulmonary oedema which we recently came across and treated successfully.