Unexpected pulmonary edema and cardiac arrest following wedge resection of spontaneous pneumothorax -A case report

Abstract

Background: Reexpansion pulmonary edema is a rare but potentially lethal complication. We report a case of suspected reexpansion pulmonary edema that led to cardiac arrest.

Case: A 16-year-old male patient underwent wedge resection due to right pneumothorax. The patient showed pink frothy sputum three hours following surgery, and a chest x-ray showed right unilateral pulmonary edema. Thirteen hours following surgery, the patient continuously showed pink frothy sputum and presented with severe hypoxemia, tachypnea, and tachycardia. After transferring to the intensive care unit (ICU), he developed ventricular tachycardia. Cardiopulmonary resuscitation was performed for 32 min. Chest X-ray showed diffuse bilateral pulmonary edema. Extracorporeal membrane oxygenation was performed. During the 65 days of ICU care, the patient became mentally alert. However, follow-up echocardiography revealed severe heart failure.

Conclusions: Rexpansion pulmonary edema can rapidly progress to diffuse bilateral pulmonary edema. Therefore, careful observation is required for the patients who show signs of pulmonary edema after reexpansion.

Keywords: Extracorporeal membrane oxygenation; Heart arrest; Pneumothorax; Pulmonary edema.

Fig. 1.

Image shows 50% pneumothorax of right lung.

Fig. 2.

Pink frothy sputum.

Fig. 3.

(A) Chest x ray taken three hours following surgery showing right side limited unilateral pulmonary edema. (B) Thirteen hours following surgery showing diffuse bilateral pulmonary edema.

Fig. 4.

Vital signs, extracorporeal membrane oxygenation (ECMO) flow, inotropic agent, vasopressor trends during ECMO institution. (A-a) Heart rate (HR) (beats/min), (A-b) blood pressure (BP) (mm/Hg), (A-c) ECMO flow (L/min), (B-a) norepinephrine (μg/kg/min), (B-b) epinephrine (μg/kg/min), (B-c) dopamine (μg/kg/min), (B-d) dobutamine (μg/kg/min). Note that on postoperative day #9, not only epinephrine, and norepinephrine, but also ECMO was terminated. ECMO was maintained for 7 days. After that, dopamine and dobutamine were tapered while maintaining stable vital signs.