Re-expansion pulmonary edema after repair of a missed diaphragmatic hernia.

R pulmonary edema (RPE) is a well-defined complication of lung re-expansion in the management of a pneumothorax or large pleural effusion. Repair of a large and longstanding traumatic diaphragmatic hernia may present a very similar physiologic situation. If the hernia is small or is promptly repaired, reduction of abdominal contents should result in lung reexpansion thus improving cardiorespiratory function. We report the case of a large, missed traumatic diaphragmatic hernia that when repaired resulted in rapid re-expansion of the lung and RPE. This required individual lung ventilation in the intensive care unit. RPE is a direct consequence of increased capillary permeability, the common endpoint of multiple physiological stressors. RPE ranges in extent from being clinically undetectable to causing respiratory failure. Severity is related to the extent and duration of the lung compression. This case serves to illustrate the phenomenon of RPE, which may occur in select cases of diaphragmatic hernia.