Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, Guangzhou, China.
Institute of Legal Medicine, Hannover Medical School, Hannover, Germany.
Forensic Sci Med Pathol. 2021 Mar;17(1):114-119. doi: 10.1007/s12024-020-00325-1. Epub 2020 Nov 10.
We describe a case of a 32-year-old man who died due to bilateral re-expansion pulmonary edema (RPE) following the insertion a chest tube for unilateral spontaneous pneumothorax. Fifteen minutes after inserting the chest tube, the patient with right spontaneous pneumothorax was diagnosed with right re-expansion edema by chest radiograph. Although multiple treatments were administered, the patient died. However, the findings from autopsy showed bilateral RPE existed in the decedent but not unilateral RPE. Autopsy, microscopic examination, and clinical records concluded that the cause of death was acute cardiac and respiratory failure due to bilateral re-expansion pulmonary edema following unilateral spontaneous pneumothorax. Bilateral RPE due to a unilateral pneumothorax is quite rare in clinical and forensic practice. To the best of our knowledge, this is the first time that the pathological changes of RPE have been described by gross and microscopic examinations. This case is reported to provide histopathologic references for diagnosis of RPE and indicate that combining death investigation, pathological findings and clinical courses plays a vital role in diagnosis of RPE in forensic pathology.
我们描述了一例 32 岁男性患者，因单侧自发性气胸插入胸腔引流管后发生双侧复张性肺水肿（RPE）而死亡。在插入胸腔引流管后 15 分钟，该名右侧自发性气胸患者被诊断为右侧复张性肺水肿。尽管进行了多种治疗，但患者仍死亡。然而，尸检结果显示死者存在双侧 RPE，而非单侧 RPE。尸检、显微镜检查和临床记录的结果表明，该患者的死亡原因是单侧自发性气胸后双侧复张性肺水肿导致的急性心呼吸衰竭。在临床和法医学实践中，由于单侧气胸引起的双侧 RPE 非常罕见。据我们所知，这是首次通过大体和显微镜检查描述 RPE 的病理变化。本病例旨在为 RPE 的诊断提供组织病理学参考，并表明结合死亡调查、病理发现和临床过程对法医病理学中 RPE 的诊断具有重要作用。
