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Shock and ipsilateral pulmonary oedema
  1. J G B Thurston
  1. Clinical Director, Accident and Emergency Department, Joyce Green Hospital, Dartford, Kent DA1 5PL

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    Editor,—I had a distinct deja vu phenomenon on reading the article by Desai and colleagues.1

    In 1970 (30 years ago) David Trapnell and I reported four patients with unilateral pulmonary oedema after pleural aspiration.2 This paper described two patients with pneumothorax but also two with pleural effusions. One of the patients, an 18 year old, died.

    The common feature of these four patients was that the air or fluid had occupied the pleural space for some time and were not acute presentations. We concluded “It is established practice in genito-urinary circles to decompress the bladder of a patient with chronic urinary retention slowly. Acute retention is relieved rapidly after insertion of a urethral catheter. We would like to suggest that the same principle of therapeutic relief be applied to the pleural space”. We believed that this important concept had not been reported previously in a group of patients and felt that medical practitioners treating chronic or relatively longstanding pleural effusions or pneumothoraces should be aware of the need to decompress the pleural space with caution.