Re-expansion pulmonary oedema: LANCET case report
A 46-year-old man presented to the emergency department with moderate dyspnoea and a 4-day history of cough. His medical history also included alcoholic cirrhosis with portal hypertension and ascites.

On admission, a chest x-ray showed complete white-out of the right hemithorax with contralateral mediastinal deviation compatible with a large pleural effusion—presumed to be hepatic hydrothorax. A chest drain was inserted into the right pleural cavity under ultrasound guidance and 2 L of clear fluid were rapidly drained over approximately 2 min.

A further chest x-ray taken the day after admission revealed a large right hydropneumothorax and a partly collapsed right lung with consolidation of the upper lobe. A second larger chest drain was inserted to ensure adequate drainage. A CT chest scan was then done to rule out any underlying lung disease; this showed near-complete resolution of the right hydropneumothorax and patchy consolidation, ground glass opacities, and septal thickening throughout the right lung—mainly in the upper and middle lobes.

Based on the clinical and radiological findings, a diagnosis of re-expansion pulmonary oedema was made. The patient recovered completely after 2 days of supportive treatment and a further chest x-ray showed clear lung fields bilaterally. The total volume drained was calculated to be 5·5 L. Pleural fluid analyses revealed a transudate with negative culture and cytology.

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