CTICasesFatal Reexpansion Pulmonary Edema with Contralateral ARDS
Imaging findings
A patient with several weeks of progressive dyspnea presents with complete left-lung whiteout and contralateral mediastinal shift; CT confirms a large chronic pleural effusion with a fluid-fluid level and left lung collapse. After emergency-department thoracentesis removes roughly two liters of old blood, serial radiographs over the following hours show progressive consolidation of the re-expanded left lung followed by new consolidation in the previously normal right lung; the patient died shortly after, without evidence of exsanguination.
Key takeaways
Rapid, severe consolidation of a re-expanded lung after large-volume thoracentesis for a chronic effusion, followed by contralateral lung injury, represents fulminant reexpansion pulmonary edema with a systemic cytokine-mediated component causing injury to the opposite lung -- a rare but recognized cause of death after thoracentesis, particularly when a large volume is removed from a lung that has been chronically collapsed.
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