Re-expansion pulmonary oedema and pleural bleeding following suction drainage of pneumothorax

We report a case of a 26-year-old male with a large left-sided spontaneous pneumothorax, whose manifestations developed 5 days prior to hospitalisation. Suction drainage was complicated by unilateral re-expansion pulmonary oedema (REPO) and bleeding into the left pleural cavity. During thoracotomy oozing of blood from multiple sites on the pleural surface was observed. Both the temporal relationship and the nature of this bleed could suggest a pathomechanism similar to that in REPO. As a result of symptomatic treatment the patient improved over the next several days and the radiological manifestations resolved. The risk factors for REPO include: young age, large volume of pneumothorax and collapse exceeding 3 days, as it was in case of our patient. In order to reduce this risk a slower re-expansion without suction drainage or with the use of reduced pressure in the initial period of treatment is recommended.