Sir.—Reexpansion pulmonary edema (REPE) is an uncommon problem that afflicts the reexpanded lung after evacuation of a large pneumothorax or pleural effusion. There are many accounts of REPE occurring in adults, but to my knowledge, this problem has not been reported in the pediatric population. A boy is described in whom severe unilateral pulmonary edema occurred after evacuation of a large pleural effusion.
Patient Report.—An 8-year-old boy weighing 40 kg was admitted for treatment of steroid-resistant nephrotic syndrome. He had no previous neurologic abnormality. The patient's medical history was remarkable for multiple bouts of infection, including a right-sided pneumococcal pneumonia 3 months before admission. One month after the pneumonia, he underwent a right pleural decortication because of recurrent pleural effusion. Two weeks before admission, a chest roentgenogram showed moderate right- and left-sided pleural effusions. During these 2 weeks, he experienced worsening shortness of breath.
On admission, the patient