While the incidence of this condition remains below 1% following procedures like thoracentesis or chest drainage, mortality rates can climb as high as 20% due to an abrupt reduction in pleural pressure.
Case Presentation of Post-Thoracentesis Edema
A 40-year-old female patient from São Paulo, Brazil, was admitted to a hospital for the investigation of dyspnea accompanied by vespertine fever, a 4 kg weight loss, and arthralgia lasting for one month, according to the case report. During a physical examination, medical staff observed that the thoracic-vocal trill and vesicular breath sounds were missing at the base of the middle third of the left hemithorax. Her peripheral oxygen saturation sat at 88% while breathing ambient air.
Radiographic assessments revealed a large left pleural effusion without evidence of mediastinal or pulmonary parenchymal abnormalities. Medical staff performed a diagnostic and therapeutic thoracentesis alongside a parietal pleura biopsy using a Cope needle. Providers removed one liter of citrine yellow pleural fluid before interrupting the procedure due to the patient experiencing chest pain.
Computed Tomography Findings and Clinical Course
A computed tomography scan performed after the procedure showed a persistent mild hydropneumothorax on the left hemithorax with no mediastinal abnormalities, according to the findings. Subsequent high-resolution imaging revealed airspace opacities on the same side within the previously deflated lung, comprising poorly defined centrilobular micronodules, prominent interlobular and intralobular septa, and overlapping patchy ground-glass opacities centered mostly in the lingula and the left inferior lobe.
The patient received spontaneous respiration with nasal oxygen. By the second post-puncture day, she demonstrated spontaneous and progressive improvement in her discomfort and oxygen saturation levels. Pleural fluid analysis revealed a lymphocytic exudate characterized by a glucose level of 106 mg/dL, an adenosine deaminase level of 56 U/L, and negative cultures for pathogens. Oncotic cytology results were negative, and pleural biopsy findings showed chronic non-specific pleuritis.
Diagnosis of Systemic Lupus Erythematosus
Further laboratory evaluations and the pleural biopsy established a definitive diagnosis of systemic lupus erythematosus, supported by hand arthritis, pleuritis, and positive anti-nuclear (1:1280) and anti-Smith (anti-Sm) antibodies, according to the clinical report. On the fourth hospital day prior to discharge, a follow-up chest tomography scan showed a reduction in both the pneumothorax and the ground-glass opacities, confirming the diagnosis of post-thoracentesis reexpansion pulmonary edema.
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