Board Review: Lets get some air


A 45-year-old female with a history of ovarian cancer presents to the ED with progressively worsening dyspnea for the past week. Upon arrival she appears to be in distress with decreased breath sounds on the left side. A CXR shown below is concerning for a tension hydrothorax. During the course of your resuscitation, you prepare to perform an emergent thoracentesis. If you remove more than 1 L of pleural fluid, what is the patient at increased risk for?


A. Pneumothorax

B. Pulmonary Edema

C. Hypotension 

D. Pneumonia 































Answer: B. This patient has a tension hydrothorax confirmed by the CXR provided which shows complete white out of the left lung with mediastinal shift to the opposite side. This CXR, and the distress of your patient, warrants an emergent thoracentesis. If more than 1 L of pleural fluid is removed, your patient is at higher risk of re-expansion pulmonary edema - a rare but potentially fatal complication thought to be due to abrupt changes in pleural pressure causing increased vascular permeability of the lung parenchyma. Treatment consists of supplemental oxygen and possibly NIPPV. Diuresis may also be used. In severe cases, the patient may require intubation prior to placement of the patient in lateral decubitus position with the affected lung down



Stawicki, Stanislaw & Sarani, Babak & Braslow, Benjamin. (2017). [Review] Reexpansion pulmonary edema. International Journal of Academic Medicine. 3. 2017. 10.4103/IJAM.IJAM_98_16. < 4/9/20