Abstract

Spontaneous pneumothorax is a common clinical condition in respiratory medicine, typically managed through either conservative measures or pleural drainage. One of the recognized complications following drainage is re-expansion pulmonary edema (REPE), which is usually mild and self-limiting. However, in rare instances, REPE can manifest severely. This report describes a case of unilateral severe REPE that developed shortly after pleural drainage for a spontaneous pneumothorax, complicated by extensive pulmonary plasma leakage. The patient experienced a sudden and critical decline in both respiratory and circulatory status. Emergency management included prone and head-down positioning to optimize ventilationperfusion matching, aggressive fluid resuscitation, and initiation of mechanical ventilation. This clinical course highlights the potential for REPE to progress rapidly to life-threatening respiratory and hemodynamic failure. Clinicians should maintain a high index of suspicion for severe pulmonary re-expansion edema in patients who deteriorate shortly after seemingly successful pleural decompression. Early recognition and supportive interventions are vital for improving outcomes in such critical presentations. In this case report, we discuss such a challenging case, its management and further course we learnt to support our readers.

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