Scope And Suction: Reexpansion Pulmonary Edema (Repe), A Complication Post-Bronchoscopy to Be Aware Of

Nik Ahmad Hatim Nik Mohammad Dziauddin* and Abu Yazid Md Noh
Department of Emergency Medicine, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
*Corresponding Author: Nik Ahmad Hatim Nik Mohammad Dziauddin, Department of Emergency Medicine, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.

Published: February 08, 2025

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Abstract  

Reexpansion pulmonary edema (REPE) is acute lung injury (ALI) with incidence of less than 1% following pneumothorax or pleural effusion evacuation, which may also occur due to excessive suction of tracheobronchial tree during bronchoscopy. 63 year old lady with hypertension and stroke presented to emergency in septic shock with temperature of 38.7°C. She had respiratory distress with lung finding of left lower zone coarse crepitation and fail to saturate in spite high-flow mask oxygen. She was intubated for impending respiratory collapse and ultrasound showed right femoral vein thrombosis with CT pulmonary angiogram confirmed of pulmonary embolism. Antibiotic and anticoagulant were started for initial treatment. Later, patient required bronchoscopy for collapse and consolidation of left lower lobe as evidence by chest X-ray. Thick mucus over left upper and lower lobes were sucked out. Immediately post procedure, patient desaturated to 90% and required greater positive end-expiratory pressure (PEEP) to maintain saturation. Repeated chest X-ray suggest left upper lobe collapse and lower lobe REPE. With adequate PEEP, REPE and lung collapse were resolved. This case describes rarely discussed complication of bronchoscopy that should be recognized as bronchoscopy is a valuable tool for diagnosing and treating airway issues in emergency settings nowadays.

Keywords: Reexpansion pulmonary edema; acute lung injury; bronchoscopy

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