Kara Sibel, Sen Nazan, Akcay Sule, Moray Gokhan, Kus Murat, Haberal Mehmet
From the Department of Chest Diseases Baskent University Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey.
Exp Clin Transplant. 2018 Mar;16 Suppl 1(Suppl 1):154-157. doi: 10.6002/ect.TOND-TDTD2017.P43.
Hydrothorax occurs frequently in patients with endstage liver disease and usually requires drainage of pulmonary effusion during the hepatectomy phase of liver transplant. Reexpansion pulmonary edema is a rare but potentially fatal complication seen after rapid reexpansion of the collapsed lung following thoracentesis of pleural fluid or tube drainage of pneumothorax. This condition, which manifests with various degrees of clinical severity, is rarely reported following liver transplantation. Herein, we present a 62-year-old male patient who developed reexpansion pulmonary edema after drainage of massive pleural effusion, which caused a total collapse in the right hemithorax during liver transplant. Six hours after pleural fluid drainage, the patient developed a nonproductive cough, mild tachypnea, shortness of breath, and low oxygen saturation (88%). His chest radiograph showed diffuse heterogeneous opacities in the right hemithorax. Computed tomography of the thorax revealed consolidations containing air bronchograms and ground glass opacities in the parenchyma of the right lung; these findings did not extend to the periphery and were observed less frequently in the inferoposterior left lung. These symptoms and radiologic findings were diagnosed as reexpansion pulmonary edema. Complete clinical and radiologic improvements were achieved within 72 hours of mechanical ventilatory support.
胸腔积液在终末期肝病患者中很常见，在肝移植的肝切除阶段通常需要引流胸腔积液。复张性肺水肿是一种罕见但可能致命的并发症，见于胸腔穿刺抽液或气胸置管引流后萎陷肺快速复张。这种病情临床表现程度各异，在肝移植后鲜有报道。在此，我们报告一名62岁男性患者，在肝移植期间大量胸腔积液引流后发生复张性肺水肿，该胸腔积液导致右半侧胸腔完全萎陷。胸腔积液引流6小时后，患者出现干咳、轻度呼吸急促、气短和低氧饱和度（88%）。他的胸部X线片显示右半侧胸腔弥漫性不均匀混浊。胸部计算机断层扫描显示右肺实质内有含气支气管征的实变影和磨玻璃影；这些表现未延伸至周边，在左肺下后段较少见。这些症状和影像学表现被诊断为复张性肺水肿。在机械通气支持72小时内实现了完全的临床和影像学改善。
