• Ephraim Teffera AAU SOM



Reexpansion pulmonary edema following repair of missed diaphragmatic hernia is very rare .Here reported is a case of bilateral reexpansion pulmonary edema occurring after reconstruction of left sided post traumatic diaphragmatic hernia. The patient was re intubated and ventilated later put on supplemental oxygen via a catheter through the endotracheal tube followed by extubation and non re breather face mask to compensate for hypoxemia. He was given intravenous diuretics and inotropic support. Forty-eight hours after the acute event, the patient recovered with minimal residual hypoxemia. Reexpansion pulmonary edema after repair of missed diaphragmatic hernia is a rare complication with a high mortality rate of up to 20%. It should be considered in cases of hypoxemia following any chest reexpansion procedure. The exact pathophysiology leading to this complication is not clear but it is believed to be permeability pulmonary edema as a result of pulmonary micro vascular damage. Risk factors for reexpansion pulmonary edema should be evaluated and considered prior to insertion of chest tubes. Treatment is supportive and emphasis should be given for preventive measures.

Key Words: Reexpansion Pulmonary Edema, Diaphragmatic Hernia


Author Biography

Ephraim Teffera, AAU SOM

Department of Surgery

Assistant Professor of Surgery

Cardiothoracic Surgeon



Symbas PN, Vlasis SE, Hatcher CR Jr. Blunt and penetrating diaphragmatic injuries with or without herniation of organs into the chest. Ann. Thoracic Surg 1986;42:158.

Carlson RI, Classen KL, Gollan F, et al. Pulmonary edema fol­lowing the rapid expansion of a totally collapsed lung due to pneumothorax: A clinical and experimental study. Surg Forum1958;9:367-371.

Eduardo Henrique Genofre, Francisco s. Vargas, Lisete r. Teixeira,Marcelo Alexandre Costa Vaz, Evaldo Marchi. Reexpansion pulmonary edema J Pneumol 2003;29(2):101-6)

Rasha Alqadi, MD, Valencia CF,Viscusi M, Latif S.Re-expansion pulmonary edema following thoracentesis. Rhode Island Medical Journal 2013;38- 40

Malota M, Kowarik M, Bechtold B, Kopp R. Re-expansion pulmonary edema following a posttraumatic pneumothorax: a case report and review of the literature. World Journal of Emergency Surgery 2011;6:321.

Matsumiya N, Dohi S, KimuraT, Naito H. Re-expansion pulmonary edema After Mediastinal Tumor Removal. Anesth Analg 1991;73:646-48.

SoharaY. Re-expansion pulmonary edema .Ann Thoracic CardivascSurg 2008;14(4):205-9.

Mahfood S, Hix WR, Aaron BL, Blaes P, Watson DC. Re-expansion pulmonary edema. Ann Thorac Surg 1988;45:340-5.

Inaba Kenji, Snider J, Holliday.Re-Expansion Pulmonary Edema After Repair Of A Missed Diaphragmatic Hernia Canadian Journal Of Surgery 2001; 44( 4): 295-7

DuBose J, Perciballi J, Timmer S, Kujawaski EJ. Bilateral re-expansion pulmonary edema after treatment of spontaneous pneumothorax. Current Surg 2004;61:376-379.

Jackson R, Veal C, Alexander B, Brannen, FulmerJ. Re-expansion Pulmonary Edema: A Potential Role for Free Radicals in Its pathogenesis". Am Rev Resp Dis1988;137(5):1165-1171

Mahajan VK, Simon M, Huber GL. Reexpansion pulmonary edema. Chest 1979;75:192-4.

Iqbal M, Multz A, Rossoff L, Lackner R. Re-expansion Pul­monary Edema After Vats Successfully Treated With Continuous Positive Airway Pressure. Ann Thorac Surg. 2000; 70:669-71.

Heller Bj, Grathwohl K. Contralateral Reexpansion Pulmonary Edema. South Med J 2000;93:828-31.

Sewel R, Fewel J, Grover F, Arom K. Experimental Evaluation of Re-expansion Pulmonary Edema. Ann Thorac Surg 1978;26:126-32.

Besalti1 O, Pekcan Z, Caliskan M, Aykut Z.A retrospective study on traumatic diaphragmatic hernias in cats. Ankara Üniv Vet Fak Derg 2011;58,175-179.

Malota M, Kowarik, Bechtold B.Kopp R. Re-expansion Pulmonary Edema Following A Posttraumatic Pneumothorax: A Case Report and Review of The Literature. World J EmergSurg 2011;6:32

Cho S, Lee J, Kim M. New Treatment Method for Re-expansion Pulmonary Edema: Differential Lung Ventilation. Ann Thorac Surg 2005,80:1933-1934.

Janmeja A,. Mohapatra P, Saini, KhuranaA; Re-expansion Pulmonary Edema- A Case Report. Lung India 2007;24:72-74

Light R. Thoracentesis and Pleural Biopsy. In Light R, Editor Pleural Disease. 4th Ed. Baltimore:Williams & Wilkins, 2003; 358-377.






Case Report