
==== Front
Respirol Case Rep
Respirol Case Rep
10.1002/(ISSN)2051-3380
RCR2
Respirology Case Reports
2051-3380
John Wiley & Sons, Ltd Chichester, UK

10.1002/rcr2.70032
RCR270032
Clinical Image
Clinical Image
Re‐expansion pulmonary edema and atelectasis due to mucus plug following chest tube placement for pneumothorax
REPE AND ATELECTASIS AFTER PNEUMOTHORAX
Nguyen‐Dang et al.
Nguyen‐Dang Nghi 1
Tran‐Le Quoc‐Khanh 1 2
Nguyen‐Ho Lam https://orcid.org/0000-0001-7171-2257
1 2 3 lam.nh@umc.edu.vn
nguyenholam@ump.edu.vn
bsholam1986@gmail.com

1 Department of Internal Medicine University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam
2 Respiratory Department Cho Ray's Hospital Ho Chi Minh City Vietnam
3 Respiratory Department University Medical Center HCMC Ho Chi Minh City Vietnam
* Correspondence
Lam Nguyen‐Ho, University Medical Center Ho Chi Minh City, 215, Hong Bang, Ward 11, district 5, Ho Chi Minh City, Vietnam.
Email: lam.nh@umc.edu.vn, nguyenholam@ump.edu.vn, or
bsholam1986@gmail.com

24 9 2024
9 2024
12 9 10.1002/rcr2.v12.9 e7003205 9 2024
16 9 2024
© 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Key message

Re‐expansion pulmonary edema (REPE) and mucus plug‐induced atelectasis are potential complications that clinicians should be aware of following chest tube placement for pneumothorax.

Re‐expansion pulmonary edema (REPE) and mucus plug‐induced atelectasis are potential complications that clinicians should be aware of following chest tube placement for pneumothorax.

atelectasis
chest tube
mucus plug
pneumothorax
re‐expansion pulmonary edema
source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:24.09.2024
Nguyen‐Dang N , Tran‐Le Q‐K , Nguyen‐Ho L . Re‐expansion pulmonary edema and atelectasis due to mucus plug following chest tube placement for pneumothorax. Respirology Case Reports. 2024;12 (9 ):e70032. 10.1002/rcr2.70032

Associate Editor: Francesca Gonnelli
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pmcCLINICAL IMAGE

A 25‐year‐old male with a 10‐pack‐year smoking history presented with sudden left‐sided pleuritic chest pain and breathlessness. Chest x‐ray (CXR) confirmed a large pneumothorax (Figure 1A), leading to chest tube thoracostomy. One‐hour post‐procedure, the patient's hypoxemia worsened, requiring endotracheal intubation. An urgent CXR showed left lung re‐expansion but new consolidation (Figure 1B). He was managed with mechanical ventilation and diuretics, resulting in improvement and extubation after 48 hours. Subsequent CXR showed complete expansion with rapid consolidation clearance, suggesting re‐expansion pulmonary edema (REPE) (Figure 1C). Three days post‐extubation, a CXR and a chest computed tomography scan (Figure 1D–F) were performed to investigate pneumothorax aetiology and revealed right lower lobe atelectasis, likely due to mucus plug from prolonged immobility and dehydration from diuretic use (he coughed up thick sputum but difficult to expectorate). Since the patient was stable, chest physiotherapy and fluid replacement were initiated, resulting in resolution (Figure 1G).

FIGURE 1 (A) On admission, chest x‐ray (CXR) shows a large left‐sided pneumothorax; (B) One hour after thoracostomy, CXR shows complete left lung expansion but new consolidation, with the chest tube correctly placed; (C) Resolution of left lung consolidation after 48 h, with endotracheal tube; (D) CXR 3 days post‐extubation shows opacity in the right lower lung, corresponding to the atelectasis seen on the concurrent computed tomography (CT) scan; (E) and (F) Chest CT scan shows complete re‐expansion of the left lung and right lower lobe collapse; (G) Resolution of right lower lobe atelectasis, the chest tube has been removed.

REPE is a rare but serious complication (<1%) of pleural drainage, 1 potentially linked to a swift rise in negative intrapleural pressure after drainage, consequently increasing vascular pressure and permeability. Risk factors include prolonged symptoms, smoking, and large pneumothorax size. 2 Mucus plug‐induced atelectasis is another complication to monitor after chest‐tube thoracostomy, often caused by impaired cough, dehydration, and immobility.

AUTHOR CONTRIBUTIONS

All authors make equal contributions to this article.

FUNDING INFORMATION

This research received no external funding.

CONFLICT OF INTEREST STATEMENT

None declared.

ETHICS STATEMENT

The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images. No identifiable patient information is included in the manuscript.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
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REFERENCES

1 Asciak R , Bedawi EO , Bhatnagar R , Clive AO , Hassan M , Lloyd H , et al. British Thoracic Society clinical statement on pleural procedures. Thorax. 2023;78 (Suppl 3 ):s43–s68. 10.1136/thorax-2022-219371 37433579
2 Willim HA , Munthe EL , Vanto Y , Sani AA . Risk factors for re‐expansion pulmonary edema following chest tube drainage in patients with spontaneous pneumothorax: a systematic review and meta‐analysis. J Cardiovasc Thorac Res. 2024;16 (1 ):1–7. 10.34172/jcvtr.32871 38584660
