DÄ internationalArchive13/2009Fulminant Unilateral Pulmonary Edema After Insertion of a Chest Tube – a Complication After a Primary Spontaneous Pneumothorax: In reply

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Fulminant Unilateral Pulmonary Edema After Insertion of a Chest Tube – a Complication After a Primary Spontaneous Pneumothorax: In reply

Dtsch Arztebl Int 2009; 106(13): 223. DOI: 10.3238/arztebl.2009.0223b

Schmidt-Horlohé, N

LNSLNS The fact that an otherwise healthy, young patient's cardiopulmonary system decompensates in such a manner owing to unilateral impairment is indeed surprising. The literature cited with our article, however, reports several such instances. The pathophysiological examination remains unclear—the shift of larger volumes of intravascular fluids into the thorax (interstitial and intra-alveolar) has been discussed as a possible mechanism (1). The need for catecholamines in the patient in our case report existed for a short period of time only, before sedation was stepped down, and the required dosage was low.

The suggested differential diagnosis of stress associated takotsubo cardiomyopathy is an interesting one. Unfortunately, we cannot refer to valid parameters in the sense of valid diagnostic tests as neither electrocardiography nor echocardiography were undertaken, nor were the respective laboratory results available. Repeated work-up of the documentation, however, does not hint at such an entity. The clinical symptoms described for takotsubo cardiomyopathy, similar to those of cardiac ischemia, were not present before intubation, after extubation, and retrospectively in the patient's further inpatient and outpatient progress (2). Isolated unilateral pulmonary edema as a result of a transient cardiac pump failure owing to the "myocardial stunning" described in the context of this disorder seems to us rather untypical. Also, female patients of an older age are regarded as having a higher risk (3). Without objective findings, takotsubo cardiomyopathy can certainly not be excluded, but to us it seems rather unlikely. If any clinical signs are present then this differential diagnosis should probably be excluded by means of suitable diagnostic tests.
DOI: 10.3238/arztebl.2009.0223b


Nina Schmidt-Horlohé
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie
GPR Klinikum Rüsselsheim, August-Bebel-Str. 59, 65428 Rüsselsheim, Germany
schmidt-horlohe@gp-ruesselsheim.de

Conflict of interest statement
The authors of both letters declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Pavlin DJ, Raghu G, Rogers TR et al.: Reexpansion hypotension. A complication of rapid evacuation of prolonged pneumothorax. Chest 1986; 89: 70–4.
2.
von Korn H, Yu J, Lotze U et al.: Tako-Tsubo-like cardiomyopathy: specific ECG findings, characterization and clinical findings in an European single center. Cardiology 2009; 112: 42–8.
3.
Vizzardi E, D'Aloia A, Zanini G et al.: Tako-tsubo-like left ventricular dysfunction: transient left ventricular apical ballooning syndrome. Int J Clin Pract 2008 (published online).
4.
Schmidt-Horlohé N, Azvedo CT, Rudig L et al.: Case report: Fulminant unilateral pulmonary edema after insertion of a chest tube: a complication after a primary spontaneous pneumothorax. [Fulminantes, unilaterales Lungenödem nach Thoraxdrainage: Eine Komplikation nach Anlage einer Drainage bei primärem Spontanpneumothorax]. Dtsch Arztebl Int 2008; 105(50): 878–81.
1. Pavlin DJ, Raghu G, Rogers TR et al.: Reexpansion hypotension. A complication of rapid evacuation of prolonged pneumothorax. Chest 1986; 89: 70–4.
2. von Korn H, Yu J, Lotze U et al.: Tako-Tsubo-like cardiomyopathy: specific ECG findings, characterization and clinical findings in an European single center. Cardiology 2009; 112: 42–8.
3. Vizzardi E, D'Aloia A, Zanini G et al.: Tako-tsubo-like left ventricular dysfunction: transient left ventricular apical ballooning syndrome. Int J Clin Pract 2008 (published online).
4. Schmidt-Horlohé N, Azvedo CT, Rudig L et al.: Case report: Fulminant unilateral pulmonary edema after insertion of a chest tube: a complication after a primary spontaneous pneumothorax. [Fulminantes, unilaterales Lungenödem nach Thoraxdrainage: Eine Komplikation nach Anlage einer Drainage bei primärem Spontanpneumothorax]. Dtsch Arztebl Int 2008; 105(50): 878–81.