CTICasesRe-expansion Pulmonary Edema
Imaging findings
Initial chest radiograph shows a large right-sided pleural effusion. After therapeutic thoracentesis, follow-up radiography shows worsening opacity and progressive consolidation in the right lung. Chest CT confirms dense, dependent lung opacities with a characteristic layering appearance, where the edema fluid forms horizontal levels within the lobules, resembling karst mountain topography.
Key takeaways
Re-expansion pulmonary edema is a well-recognized clinical phenomenon that can occur after rapid evacuation of a large, chronic pleural effusion or pneumothorax. The sudden re-expansion of the collapsed lung leads to alveolar capillary membrane injury, microvascular dysfunction, and localized edema. On CT, this edema can manifest with a distinctive layering, jagged-edged pattern within the lobules, which has been descriptively likened to karst limestone topography.
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