Usually, most of the reported cases were described as an ipsilateral MM-102 concentration RPE, but there are few patients with contra- or even bilateral edema, which seem to raise the mortality. Her and Mandy published

3 cases with a contralateral RPE after a right upper lobectomy for cancer, a drainage of a pleural effusion and an intraoperative collapse during non thoracic surgery. In all cases, the RPE in the contralateral lung occurred faster and more severe than in the collapsed side [10]. Appraising the temporal dynamic, the first symptoms often occur within the first hour up to 24 hours after the re-expansion of the lung [7]. As we know from a 22 case series published by Gleeson, who reviewed the CT scans of patients with RPE, the most common CT findings of reexpansion pulmonary edema include ipsilateral ground-glass opacities, septal thickening, foci of consolidation and areas of atelectasis [11]. The aetiology depends on multiple factors; however the pathophysiological process has not yet been completely explored. From several animal experiments it could be seen, that a chronic lung collapse causes a thickening of the capillary endothelium by the release of MCP1 (monocyte chemoattractant MK-0457 protein 1), Leukotriene B4 and IL-8 (Interleukin 8). On reexpansion of the lung, the microvessels are suddenly stretched,

which harms their endothelium. Thereby the capillary permeability is increased and a loss of alveolar surfactant can be observed. Thus the perivascular pressure of the microvessels

decreases, which leads to further endothelial damage. In addition to that, it could be demonstrated, that oxidases are induced, Selleck GSK1120212 which leads to apoptosis of alveolar and endothelial cells [12, 13]. The treatment for RPE is symptomatic. Apart from monitoring the patient’s vital parameters, invasive respiration with a high positive end-expiratory pressure may be necessary to reexpand the collapsed alveoli. Supportively anti-inflammatory drugs and diuretics should be given [14]. Conclusion Although the RPE is a rare complication after the treatment of a pneumothorax, the physician should be aware of the severity of this disease pattern and always keep MRIP it in mind. Furthermore he should be aware of the fact that it can as well occur after a traumatic pneumothorax. Consent Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. References 1. Mahfood S, Hix WR, Aaron BL: Reexpansion pulmonary edema. Ann Thorac Surg 1998, 45:340–345.CrossRef 2. Pinault H: Considérations cliniques sur la thoracentèse. 1853 [doctoral thesis]. Paris 3. Carlson RI, Classen KL, Gollan F: Pulmonary edema following the rapid expansion of a totally collapsed lung due to pneumothorax: A clinical and experimental study. Surg Forum 1958, 9:367–371.PubMed 4.