Unilateral re-expansion pulmonary oedema treated with C-PAP

Unilateral re-expansion pulmonary oedema is a rare but dangerous complication of treatment for pulmonary atelectasis, pleural effusion and pneumothorax, whose pathogenesis is not completely known. The clinical picture varies considerably from asymptomatic forms with positive radiographic findings to forms with severe respiratory insufficiency and haemodynamic instability. Little data is available in literature on the treatment of re-expansion pulmonary oedema with non-invasive continuous positive airway pressure ventilation. In this article, we describe the case of a 75 year-old man who reported to our Emergency Department with extensive spontaneous left pneumothorax. Following placement of the transthoracic drain, the patient presented a clinical picture of severe respiratory insufficiency with circulatory collapse caused by unilateral re-expansion pulmonary oedema. The case was successfully treated with the application of non-invasive continuous positive airway pressure ventilation. The article briefly discusses current knowledge with regard to the aetiological and pathogenetic factors of this complication of emergency pneumothorax treatment.