Pulmonary edema overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pulmonary edema is fluid accumulation in the lungs. This fluid accumulation leads to impaired gas exchange and hypoxia.
Historical Perspective
Pulmonary edema was first described as a result of heart failure by Andreas Nerlich. In 1891 the first case of high altitude pulmonary edema was reported. In 1908, W. T. Shanahan noted acute pulmonary edema as an adverse effect of epileptic seizures.
Classification
Pulmonary edema can be classified on the basis of etiology into 2 subtypes, including cardiogenic pulmonary edema (left ventricular failure, myocardial infarction, left ventricle hypertrophy cardiomyopathy) and, noncardiogenic pulmonary edema (acute respiratory distress syndrome, pneumonia, pulmonary embolism, chest trauma).
Pathophysiology
Pulmonary edema is due to either failure of the heart to remove fluid from the lung circulation ("cardiogenic pulmonary edema"), or due to a direct injury to the lung parenchyma or increased permeability or leakiness of the capillaries ("noncardiogenic pulmonary edema").[1]
Causes
Differentiating Pulmonary edema from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Some patients may need to use a breathing machine for a long time, which may lead to damage to lung tissue.Kidney failure and damage to other major organs may occur if blood and oxygen flow are not restored promptly. If not treated, this condition can be fatal. If left untreated, acute pulmonary edema can lead to coma and even death, generally due to its main complication of hypoxia.
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
The diagnosis is confirmed on X-ray of the lungs, which shows increased fluid in the alveolar walls. Kerley B lines, increased vascular filling, pleural effusions, upper lobe diversion (increased blood flow to the higher parts of the lung) may be indicative of cardiogenic pulmonary edema, while patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema
CT
Echocardiography
Echocardiography is useful in confirming a cardiac or no-cardiac cause of pulmonary edema. Among cardiac causes, echocardiography can identify if systolic or diastolic dysfunction is present. Echocardiography is useful in identify if focal segment wall motion abnormalities are present which would suggest ischemia or myocardial infarction as an underlying cause. If there is a global impairment of left ventricular function, then this suggests a cardiomyopathy may be present. Echocardiography may identify the presence and severity of valvular causes of pulmonary edema including aortic stenosis, aortic insufficiency, mitral stenosis. mitral insufficiency, and hypertrophic cardiomyopathy.
Other imaging findings
Other diagnostic findings
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ Ware LB, Matthay MA. Acute pulmonary edema. N Engl J Med 2005;353:2788-96. PMID 16382065.