Unilateral pulmonary oedema is a rare complication in the routine management of spontaneous pneumothorax. Previous reports have emphasized excessive negative intrapleural pressure, rapid re-expansion of the lung and bronchial obstruction as major factors in the pathogenesis. We have encountered four cases, and at least one of these factors have been absent in each case. Review of the literature, and our own experience suggests that the major factor is chronic and total lung collapse resulting in hypoxia and increased alveolar-capillary membrane permeability. Other factors which may be contributory are discussed.
References
1.
AdrianiJ., ZepernickR., HarwonW., and HiernB. (1967): “Iatrogenic Pulmonary Oedema in Surgical Patients”, Surgery, 61, 183.
2.
AveryM. E., and ChernickV. (1963): “Alterations of the Alveolar Lining Layer in Rabbits”, J. Pediat., 63, 762.
3.
BarachA. L., MartinJ., and EckmanM. (1938): “Positive Pressure Respiration and its Application to the Treatment of Acute Pulmonary Oedema”, Ann. Intern. Med., 12, 754.
4.
CameronG. R. (1948): “Pulmonary Oedema (Sydney Ringer Memorial Lecture)”, Brit. Med. J., 1, 965.
5.
CarlsonR. I., ClassenK. L., GollanF. (1959): “Pulmonary Oedema Following the Rapid Re-Expansion of a Totally Collapsed Lung Due to a Pneumothorax; A Clinical and Experimental Study”, Surg. Forum, 9, 367.
6.
ChildressM. E., MoyG., and MottramM. (1971): “Unilateral Pulmonary Oedema Resulting from Treatment of Spontaneous Pneumothorax”, Amer. Rev. Resp. Dis., 104, 119.
7.
ClagettO. (1968): “The Management of Spontaneous Pneumothorax”, Editorial. J. Thorac. and Cardiovas. Surg., 55, 761.
8.
ClementsJ. A., BrownE. S., and JohnsonR. P. (1958): “Pulmonary Surface Tension and the Mucus Lining of the Lungs—Some Theoretical Considerations”, J. Appl. Physiol., 12, 262.
9.
CoryllosP. M., and BirnbaumG. L. (1929): “Circulation in Compressed Atelectatic Pneumonic Lung” (Pneumothorax — Apneumatosis — Pneumonia), Arch. Surg., 19, 134.
10.
DrinkerC. K. (1954): The Clinical Physiology of the Lungs, C. C. Thomas, Springfield, Illinois, pp. 21–37.
11.
FelsonB. (1960): Fundamentals of Chest Roentgenology, W. B. Saunders Co., Philadelphia, p. 52.
12.
FennW. D. (1951): “Mechanics of Respiration’ Amer. J. Med., 10, 77.
13.
FinleyJ. N., HillT. R., and BonicaJ. J. (1963): “Effect of Intrapleural Pressure on Pulmonary Shunt Through Atelectatic Dog Lung”, Amer. J. Physiol., 205, 1187.
14.
FinleyT. N., TooleyW. H., SwensonE. W., GardnerR. E., and ClementsJ. A. (1964): “Pulmonary Surface Tension in Experimental Atelectasis”, Amer. Rev. Resp. Dis., 89, 372.
15.
FoucatA. (1875): De la Morte Subite ou Rapide Apres la Thoracocentise, Paris.
16.
GouldD. M., and TorranceD. J. (1955): “Pulmonary Oedema”, Amer. J. Roentgen, 73, 366.
17.
HartleyP. H-S. (1905): “Albuminous Expectoration Following Paracentesis of the Chest”, St. Bartholomew's Hospital Reports, 41, 77.
18.
HumphreysR. L., and BerneA. S. (1970): “Rapid Re-Expansion of Pneumothorax. A Cause of Unilateral Pulmonary Oedema”, Radiology, 96, 509.
19.
LuisadaA. A., and CardiL. (1956): “Acute Pulmonary Oedema; Pathology, Physiology and Clinical Management”, Circulation, 13, 113.
20.
MillerW. C., ToonR., PalatH., and LacroixJ. (1973): “Experimental Pulmonary Oedema Following Re-Expansion of Pneumothorax”, Amer. Rev. Resp. Dis., 108, 664.
21.
NeffT. A. (1972): “Unilateral Pulmonary Oedema Resulting from Treatment of Spontaneous Pneumothorax. Correspondence”, Amer. Rev. Resp. Dis., 105, 318.
ReismanD. (1902): “Albuminous Expectoration Following Thoracentesis”, Amer. J. Med. Sci., 123, 620.
24.
SaidS. J., BanerjeeC. M.HarlanW. R., and AveryM. E. (1967): “Pulmonary Oedema as a Cause of Surfactant Deficiency”, Jap. Heart. J., 8, 742.
25.
TooleyW. H., Discussion of AveryM. E., and ChernickV. (1963): J. Pediat., 63, 763.
26.
TrapnellD. H., and ThurstonJ. G. (1970): “Unilateral Pulmonary Oedema After Pleural Aspiration”, Lancet, 1, 1367.
27.
VisscherM. 13., HaddF. J., and StephensG. (1956): “The Physiology and Pharmacology of Lung Oedema”, Pharmacol. Rev., 8, 389.
28.
ZiskindM. M., WeillH., and GeorgeR. A. (1965): “Acute Pulmonary Oedema Following the Treatment of Spontaneous Pneumothorax with Excessive Negative Intrapleural Pressure”, Amer. Rev. Resp. Dis., 92, 632.
