Closed thoracostomy is a procedure commonly performed by emergency physicians throughout their working duties. Re-expansion pulmonary edema (REPE) is a relatively rare complication that occurs in 1 Kim YK Kim H Lee CC et al. New classification and clinical characteristics of reexpansion pulmonary edema after treatment of spontaneous pneumothorax.

Am J Emerg Med. 2009; 27: 961-967

). The precise pathophysiology of REPE has not been fully elucidated, but alterations in pulmonary microvasculature permeability and mechanical stress placed on the rapidly re-expanding lung are thought to be involved. Risk factors for complications include pulmonary collapse for a longer duration (> 4 days), younger age (younger than 40 years), large pneumothorax or pleural effusion (> 30% of lung volume), and rapid inflation of the lung over a short period ( 2 Reexpansion pulmonary edema: a case report and review of the current literature.

J Emerg Med. 2003; 24: 23-27

). Many authors advise draining not more than 1 L of fluid or air at once, and using an underwater-seal drainage apparatus rather than negative suction ( 3 Terndrup TE Bosco SF McLean ER. Spontaneous pneumothorax complicating pregnancy case report and review of the literature.

J Emerg Med. 1989; 7: 245-248

). REPE is often self-limiting and treatment is generally conservative and supportive, but REPE can be fatal. In this short report, we describe a case of serious REPE after closed thoracostomy for spontaneous pneumothorax.