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Pulmonary Re-expansion

aka Oncological Quandary 004

45 year old woman with metastatic ovarian cancer is admitted for VATS pleurodesis (video-assisted thoracoscopic surgery) and drainage of bilateral pleural effusions.

Her admission chest X-ray is shown below:

During her operation, 2L of fluid is drained from the left chest. Shortly thereafter, pink frothy sputum starts coming out of the ET tube and the patient markedly desaturates. The patient is transferred to the intensive care unit. The following chest x-ray is obtained:


Questions

Q1. Describe and interpret the above chest x-ray.

Answer and interpretation
  • Most importantly there is near white-out of the left hemi-thorax.
  • There is an ET tube, a right IJ central line and bilateral chest drains in situ.
  • There is also ECG monitoring on the patient.

Q2. What is the likely diagnosis?

Answer and interpretation

The history and CXR appearances suggest re-expansion pulmonary oedema


Q3. What are the risk factors for this condition developing?

Answer and interpretation

Risk factors include:

  • long-standing collapse of the lung prior to aspiration
  • drainage of a large amount of fluid or air over a short period of time
  • application of suction

Q4. What is Meigs syndrome?

Answer and interpretation

Meigs syndrome is the triad of:

  1. ascites,
  2. pleural effusion and
  3. benign ovarian tumor (fibroma)

It resolves after the resection of the tumor. For reasons unknown, the pleural effusion is classically on the right side. This patient has metastatic ovarian cancer with associated pleural effusion so this is not it!

Joe Vincent Meigs (1892-1963) was an American obstetrician and gynecologist. Meigs was a grandson of Captain Joe Vincent Meigs, who invented an experimental steam monorail known as the Meigs single-track elevated railroad.


References

Oncological Quandary 700

CLINICAL CASES

Oncology Quandary

Intensivist in Wellington, New Zealand. Started out in ED, but now feels physically ill whenever he steps foot on the front line. Clinical researcher, kite-surfer  | @DogICUma |

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