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Re-expansion pulmonary oedema after thoracentesis — SCE Acute Medicine MCQ

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HardRespiratory medicineRe-expansion pulmonary oedema after thoracentesisSCE Acute Medicine

A 76-year-old woman develops sudden breathlessness 2 hours after therapeutic thoracentesis for a large chronic pleural effusion. Oxygen saturation is 86% on air and chest radiograph shows diffuse alveolar shadowing in the re-expanded lung without pneumothorax. She is afebrile and her JVP is not raised. What is the most likely diagnosis?

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Correct answer: A — Re-expansion pulmonary oedema

Re-expansion pulmonary oedema can occur after drainage of a large or longstanding pleural effusion and causes hypoxia with unilateral alveolar shadowing in the re-expanded lung. Pneumothorax must be considered, but the radiograph described does not show pleural air and the pattern is parenchymal. The key prevention point is careful drainage with symptom monitoring rather than rapid unrestricted removal of large volumes.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/#acute-medicine-order-87-1