The Paradox of Relief: Recognizing and Managing Re-expansion Pulmonary Edema Following Traumatic Hemothorax

A 20-year-old male presented two days after a road traffic injury with chest pain and breathlessness. Evaluation revealed a left-sided hemothorax with multiple rib fractures. Tube thoracostomy was done using a standard blunt dissection technique, under aseptic precautions, and drained 1100 mL of blood. Within two hours, the patient developed acute respiratory distress and hypoxia. Clinical and radiological findings, including diffuse crepitations, white-out of the left lung on chest X-ray, and consolidation with air bronchograms on CT, were consistent with re-expansion pulmonary edema (REPE). He was managed with noninvasive ventilation and supportive care in the intensive care unit. The patient improved steadily and was discharged on day 8. REPE is a rare complication of tube thoracostomy, particularly in trauma. This case highlights the importance of recognizing REPE early, even in acute settings, and emphasizes the need for cautious drainage of large-volume collections.