Reexpansion Pulmonary Edema Following Postoperative Thoracentesis After Combined Coronary Artery Bypass Grafting and Mitral Valve Surgery: A Case Report.

Reexpansion pulmonary edema (REPE) is an uncommon but potentially life-threatening complication following rapid evacuation of air or fluid from the pleural space. Diagnosis can be challenging in postoperative cardiothoracic patients because clinical and radiographic findings may overlap with more common causes of acute respiratory failure, including cardiogenic pulmonary edema and fluid overload. A 55-year-old female underwent urgent triple-vessel coronary artery bypass grafting and mitral valve repair for acute ST-segment elevation myocardial infarction. Her postoperative course was complicated by bilateral pleural effusions requiring therapeutic thoracentesis on postoperative day 13. Following removal of approximately 800 mL of serosanguineous fluid, she developed acute dyspnea, worsening hypoxemia, and rapidly escalating oxygen requirements. Repeat chest imaging demonstrated new bilateral pulmonary infiltrates without pneumothorax, raising concern for REPE. She was managed with high-flow oxygen therapy, intensive care monitoring, and supportive care, with gradual improvement in respiratory status. This case illustrates the importance of considering REPE in postoperative cardiac surgery patients who develop acute respiratory deterioration after thoracentesis, even after relatively small-volume fluid removal. Recognition of the temporal relationship between pleural drainage and respiratory decline is critical for early diagnosis and avoidance of unnecessary evaluation for alternative postoperative complications.