{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:43:00Z","timestamp":1789926180471,"version":"4.0.1"},"reference-count":28,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Re-expansion pulmonary edema is a rare and potentially life-threatening complication that can occur after the rapid re-expansion of a collapsed lung due to pneumothorax or pleural effusion. It has a multifactorial pathogenesis, and risk factors for re-expansion pulmonary edema, such as chronic lung collapse, rapid re-expansion, and changes in pulmonary vascular permeability, have been identified. Clinical manifestations vary, ranging from almost asymptomatic to a rapidly fatal condition, and its incidence may be more common and less fatal than previously believed. The literature emphasizes the importance of early recognition and management to ensure favorable outcomes. However, there is ongoing debate regarding the indications for ventilatory support and the timing of non-invasive or invasive ventilation. Herein, we report a case series of three paradigmatic examples of massive re-expansion pulmonary edema occurring over a period of 10 years in our institution among a population of 815 patients with spontaneous pneumothorax. We also conducted a literature review on re-expansion pulmonary edema, with a particular focus on diagnosis and management. In each case, despite initially normal clinical parameters, severe respiratory distress developed following the insertion of a thoracic drainage tube for a massive spontaneous pneumothorax. Two patients required High-Flow Nasal Oxygen, and one was addressed to intensive management, including CPAP. In all cases, the patient\u2019s outcome was optimal.<\/jats:p>","DOI":"10.3390\/jcm13092667","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T03:57:56Z","timestamp":1714622276000},"page":"2667","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Re-Expansion Pulmonary Edema as a Life-Threatening Complication in Massive, Long-Standing Pneumothorax: A Case Series and Literature Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Giacomo","family":"Cusumano","sequence":"first","affiliation":[{"name":"Department of General Thoracic Surgery, Azienda Ospedaliero Universitaria Policlinico \u201cG.Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-7554","authenticated-orcid":false,"given":"Luigi","family":"La Via","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico \u201cG.Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Terminella","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Azienda Ospedaliero Universitaria Policlinico \u201cG.Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9331-2788","authenticated-orcid":false,"given":"Massimiliano","family":"Sorbello","sequence":"additional","affiliation":[{"name":"UOC Anestesia e Rianimazione, Giovanni Paolo II Hospital, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"13478","DOI":"10.1038\/s41598-023-39717-y","article-title":"Trends in Recurrence of Primary Spontaneous Pneumothorax in Young Population after Treatment for First Episode Based on a Nationwide Population Data","volume":"13","author":"Yi","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1089\/lap.2019.0742","article-title":"Management of the Pediatric Spontaneous Pneumothorax: The Role of Video-Assisted Thoracoscopic Surgery","volume":"30","author":"Gudelj","year":"2020","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_3","unstructured":"Hippolyte Armand, P. (1853). Consid\u00e9rations Cliniques Sur la Thoracent\u00e8se. These de Paris, (In French)."},{"key":"ref_4","first-page":"630","article-title":"Albuminous expectoration following thoracocentesis","volume":"123","author":"Riesman","year":"1902","journal-title":"Am. J. Med. Sci."},{"key":"ref_5","first-page":"77","article-title":"Albuminous expectoration following para-centesis of the chest","volume":"41","author":"Hartley","year":"1905","journal-title":"St Bartholomew\u2019s Hosp. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1016\/j.athoracsur.2007.06.038","article-title":"Large-volume thoracentesis and the risk of reexpansion pulmonary edema","volume":"84","author":"Berkowitz","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/S0003-4975(10)62480-0","article-title":"Reexpansion pulmonary edema","volume":"45","author":"Mahfood","year":"1988","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1378\/chest.100.6.1562","article-title":"Clinical analysis of reexpansion pulmonary edema","volume":"100","author":"Matsuura","year":"1991","journal-title":"Chest"},{"key":"ref_9","first-page":"460","article-title":"Re-expansion pulmonary edema: Evidence for increased capillary permeability","volume":"125","author":"Buczko","year":"1981","journal-title":"Can. Med. Assoc. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/0002-9343(81)90188-1","article-title":"Evidence for increased permeability in reexpansion pulmonary edema","volume":"71","author":"Sprung","year":"1981","journal-title":"Am. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1510\/icvts.2008.178087","article-title":"Does re-expansion pulmonary oedema exist?","volume":"7","author":"Echevarria","year":"2008","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/S0954-6111(96)90293-0","article-title":"Re-expansion pulmonary oedema following spontaneous pneumothorax","volume":"90","author":"Rozenman","year":"1996","journal-title":"Respir. Med."},{"key":"ref_13","first-page":"654","article-title":"Experimental pulmonary edema following re-expansion of pneumothorax","volume":"108","author":"Miller","year":"1973","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_14","first-page":"1187","article-title":"An analysis of and new risk factors for reexpansion pulmonary edema following spontaneous pneumothorax","volume":"6","author":"Taira","year":"2014","journal-title":"J. Thorac. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"ii61","DOI":"10.1136\/thx.2010.137026","article-title":"Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010","volume":"65","author":"Havelock","year":"2010","journal-title":"Thorax"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.29390\/cjrt-2022-047","article-title":"Pleural manometry during thoracocentesis in patients with malignant pleural effusion: A randomized controlled trial","volume":"59","author":"Hassaballa","year":"2023","journal-title":"Can. J. Respir. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1164\/rccm.201807-1415ST","article-title":"Management of Malignant Pleural Effusions. An Official ATS\/STS\/STR Clinical Practice Guideline","volume":"198","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_18","first-page":"205","article-title":"Reexpansion pulmonary edema","volume":"14","author":"Sohara","year":"2008","journal-title":"Ann. Thorac. Cardiovasc. Surg. Off. J. Assoc. Thorac. Cardiovasc. Surg. Asia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e134","DOI":"10.4187\/respcare.03759","article-title":"Severe Re-expansion Pulmonary Edema Induced by One-Lung Ventilation","volume":"60","author":"Sugiyama","year":"2015","journal-title":"Respir. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1053\/j.jvca.2007.01.014","article-title":"Reexpansion pulmonary edema","volume":"21","author":"Neustein","year":"2007","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/00005382-199601130-00004","article-title":"Reexpansion pulmonary edema","volume":"11","author":"Tarver","year":"1996","journal-title":"J. Thorac. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1016\/j.athoracsur.2004.06.029","article-title":"New treatment method for reexpansion pulmonary edema: Differential lung ventilation","volume":"80","author":"Cho","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"272","DOI":"10.21037\/atm.2019.05.08","article-title":"High-flow oxygen therapy for treating re-expansion pulmonary edema","volume":"7","author":"Lee","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.pulmoe.2021.01.011","article-title":"High-flow nasal oxygen in re-expansion pulmonary oedema","volume":"27","author":"Fontoura","year":"2021","journal-title":"Pulmonology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1056\/NEJMicm050849","article-title":"Images in clinical medicine. Reexpansion pulmonary edema after treatment of pneumothorax","volume":"354","author":"Tariq","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1007\/s00228-022-03374-3","article-title":"Use of Ketamine in Patients with Refractory Severe Asthma Exacerbations: Systematic Review of Prospective Studies","volume":"78","author":"Sanfilippo","year":"2022","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"367","DOI":"10.23736\/S0031-0808.18.03565-6","article-title":"Competences in bronchoscopy for Intensive Care Unit, anesthesiology, thoracic surgery and lung transplantation","volume":"61","author":"Solidoro","year":"2019","journal-title":"Panminerva Medica"},{"key":"ref_28","first-page":"643","article-title":"A case of anesthetic management for re-expansion pulmonary edema of the dependent lung saved by superimposed HFJV during one lung ventilation for the thoracoscopic operation associated with bilateral pneumothorax","volume":"49","author":"Wake","year":"2000","journal-title":"Masui Jpn. J. Anesthesiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2667\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:38:29Z","timestamp":1760107109000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2667"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,2]]},"references-count":28,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jcm13092667"],"URL":"https:\/\/doi.org\/10.3390\/jcm13092667","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,2]]}}}