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| | __NOTOC__ |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = Pulmonary edema | | | Name = Pulmonary edema | |
| Image = pulmonary edema.gif| | | Image = pulmonary edema.gif| |
| Caption = Chest x-ray showing pulmonary edema| | | Caption = Chest x-ray showing pulmonary edema| |
| DiseasesDB = 11017 |
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| ICD10 = {{ICD10|J|81||j|80}} |
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| ICD9 = {{ICD9|514}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 000140 |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| eMedicine_mult = |
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| }} | | }} |
| {{Template:Pulmonary edema}} | | {{Template:Pulmonary edema}} |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | | {{CMG}}; '''Associate Editor-In-Chief:''' {{FKH}} |
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| ==Natural History, Complications and Prognosis==
| | {{SK}} Pulmonary edema; lung edema; lung congestion; lung water; pulmonary congestion |
| If left untreated, acute pulmonary edema can lead to [[coma]] and even death, generally due to its main complication of [[Hypoxia (medical)|hypoxia]].
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| ==Diagnosis== | | ==[[Pulmonary edema overview|Overview]]== |
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| | ==[[Pulmonary edema historical perspective|Historical Perspective]]== |
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| | ==[[Pulmonary edema classification|Classification]]== |
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| ===Physical Examination=== | | ==[[Pulmonary edema pathophysiology|Pathophysiology]]== |
| ====General Appearance of the Patient====
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| *Anxious
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| *Decrease in level of [[alertness]] ([[consciousness]])
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| *Inability to speak in full sentences
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| ====HEENT==== | |
| *Nasal flaring
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| ====Lungs====
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| *End-inspiratory [[crackles]] (sounds heard at the end of a deep breath)
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| ====Cardiovascular====
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| *A [[third heart sound]] ([[S3]]) may be present<ref name=Ware/>
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| ==Laboratory Studies== | | ==[[Pulmonary edema causes|Causes]]== |
| ===Brain Natriuretic Peptide===
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| [[Brain natriuretic peptide|B-type natriuretic peptide]] (BNP) is elevated in the patient with cardiogenic pulmonary edema. A low BNP (<100 pg/ml) makes a cardiac cause very unlikely and is associated with non-cardiogenic pulmonary edema.<ref name=Ware/> | |
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| ===Oxygen Saturation=== | | ==[[Pulmonary edema differential diagnosis|Differentiating Pulmonary Edema from other Diseases]]== |
| Low [[oxygen saturation]] or hypoxia may be present on [[arterial blood gas]] readings.
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| ==Chest X Ray== | | ==[[Pulmonary edema epidemiology and demographics|Epidemiology and Demographics]]== |
| [[Image:Pulmonary edema.gif|right|Pulmonary edema|250px]]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 effusion]]s, 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<ref name=Ware/> | |
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| ==Echocardiography== | | ==[[Pulmonary edema risk factors|Risk Factors]]== |
| [[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]]. | |
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| ==Cardiac Catheterization== | | ==[[Pulmonary edema natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Insertion of a [[pulmonary arterial catheter]] (a.k.a. a [[Swan-Ganz catheter]]) may be required to distinguish between the two main forms of pulmonary edema and to help guide management<ref name=Ware/>. In patients with cardiogenic pulmonary edema the pulmonary artery pressure will be elevated. Among patients with non-cardiogenic pulmonary edema the wedge pressure will not be elevated.
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| ==Treatment== | | ==Diagnosis== |
| ''See also the chapter on [[congestive heart failure]]''.
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| ===Acute Pulmonary Edema===
| | [[Pulmonary edema history and symptoms|History and Symptoms]] | [[Pulmonary edema physical examination|Physical Examination]] | [[Pulmonary edema laboratory tests|Laboratory Findings]] | [[Pulmonary edema chest x ray|X Ray]] | [[Pulmonary edema CT|CT]] | [[Pulmonary edema echocardiography|Echocardiography]] | [[Pulmonary edema other diagnostic studies|Other Diagnostic Studies]] |
| In patients with acute pulmonary edema, the goal is to reduce both [[preload]] and [[afterload]] and to [[diurese]] the patient. Intravenous nitroglycerin can be used to reduce both the preload and afterload. Diuretics such as [[furosemide]] or [[bumetanide]] can be used to reduce volume overload. The dose that the patient is on chronically should be doubled and administered intravenously in the setting of flash pulmonary edema. [[Morphine sulfate]] may be helpful in reducing the drive to breathe, improving patient comfort, and reducing the [[preload]].
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| Oxygen therapy is required to minimize [[cyanosis]] and to maintain adequate oxygenation. High-flow oxygen, noninvasive ventilation (either [[continuous positive airway pressure]] (CPAP) or variable positive airway pressure (VPAP) may be effective<ref>Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. ''JAMA'' 2005;294:3124-30. PMID 16380593.</ref><ref>Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. ''Lancet'' 2006;367(9517):1155-63. PMID 16616558.</ref>). If the simple measures are not effective then [[mechanical ventilation]] may be required.
| | ==Treatment== |
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| Treatment should also be directed at managing the underlying cause of an episode of acute pulmonary edema. This would include managing as [[acute myocardial infarction]], [[mitral regurgitation]], [[aortic regurgitation]], or any other condition that causes an increase in left ventricular filling pressures.
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| ===Chronic Pulmonary Edema=== | |
| Reoccurrence of FPE is thought to be associated with [[hypertension]]<ref>Kramer K, Kirkman P, Kitzman D, Little WC. Flash pulmonary edema: association with hypertension and reoccurrence despite coronary revascularization. Am Heart J. 2000 Sep;140(3):451-5. PMID 10966547.</ref> and may signify [[renal artery stenosis]].<ref>Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, Silane MF, Laragh JH. Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. ''Lancet'' 1988;2(8610):551-2. PMID 2900930.</ref> Prevention of reoccurrence is based on managing hypertension, coronary artery disease, renovascular hypertension, and heart failure.
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| ==Pathology and Case Report==
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| ===Clinical Summary===
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| A 69-year-old male with well-controlled Type I [[diabetes mellitus]] (insulin-dependent) presented with upper abdominal and lower [[chest pain]] of four hours duration and accompanied by [[shortness of breath]] and [[diaphoresis]].
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| An [[electrocardiogram]] revealed multiple [[premature ventricular contraction]]s (PVCs).
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| The hospital course was characterized by recurrent [[pulmonary edema]] and [[oliguria]].
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| The terminal event was [[cardiac arrest]].
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| ===Autopsy Study===
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| Significant findings at postmortem examination were old and recent [[myocardial infarction]]s and evidence of [[congestive heart failure]].
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| The right and left lungs weighed 950 grams and 750 grams, respectively, and were reddish-brown.
| | [[Pulmonary edema medical therapy|Medical Therapy]] | | [[Pulmonary edema surgery|Surgery]] | [[Pulmonary edema primary prevention|Primary Prevention]] | [[Pulmonary edema secondary prevention|Secondary Prevention]] | [[Pulmonary edema cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pulmonary edema future or investigational therapies|Future or Investigational Therapies]] |
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| ===Histopathological Findings=== | | ==Case Studies== |
| [http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| <div align="left">
| | [[Pulmonary edema case study one|Case #1]] |
| <gallery heights="125" widths="125">
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| Image:Pulmonary edema case 1.1.jpg|This is a gross photograph of lungs that are distended and red. The reddish coloration of the tissue is due to congestion. Some normal pink lung tissue is seen at the edges of the lungs (arrows).
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| Image:Pulmonary edema case 1.2.jpg|This is a gross photograph of lung demonstrating acute pulmonary congestion and edema. A frothy exudate fills the bronchus (arrow).
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| Image:Pulmonary edema case 1.3.jpg|This gross photograph demonstrates the frothy exudate that is being extruded from the lung tissue.
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| </gallery>
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| </div>
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| | | ==Related Chapters== |
| <div align="left">
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| <gallery heights="125" widths="125">
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| Image:Pulmonary edema case 1.4.jpg|This is a low-power photomicrograph of lung from this case. The lung section has a pale-red color indicating proteinaceous material within the lung.
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| Image:Pulmonary edema case 1.5.jpg|This is a higher-power photomicrograph of lung. The edema fluid within the alveoli is visible at this higher magnification (arrows). The thickened pleura (1) is on the left.
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="125" widths="125">
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| Image:Pulmonary edema case 1.6.jpg|This is a higher-power photomicrograph showing edema-filled alveoli in the right portion of this section (arrows).
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| Image:Pulmonary edema case 1.7.jpg|This high-power photomicrograph illustrates the edema fluid within the alveoli (1) and the congestion (RBCs) in the alveolar capillaries (arrows).
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| </gallery>
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| </div>
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| ==References==
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| {{reflist|2}}
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| ==See also==
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| *[[High Altitude Pulmonary Edema]] | | *[[High Altitude Pulmonary Edema]] |
| *[[Myocardial infarction]] | | *[[Myocardial infarction]] |
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| {{Respiratory pathology}} | | {{Respiratory pathology}} |
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| [[bs:Akutni edem pluća]]
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| [[de:Höhenlungenödem]]
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| [[es:Edema agudo de pulmón]] | | [[es:Edema agudo de pulmón]] |
| [[ko:폐부종]]
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| [[it:Edema polmonare acuto]]
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| [[he:בצקת ריאות]]
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| [[nl:Longoedeem]]
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| [[new:पल्मोनरी इडिमा]]
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| [[ja:肺水腫]] | | [[ja:肺水腫]] |
| [[pt:Edema pulmonar]] | | [[pt:Edema pulmonar]] |
| [[sr:Акутни едем плућа]]
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| [[fi:Keuhkoödeema]]
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| [[sv:Lungödem]]
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| [[pl:Obrzęk płuc]] | | [[pl:Obrzęk płuc]] |
| [[tr:Akciğer ödemi]] | | [[tr:Akciğer ödemi]] |
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| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Mountaineering]]
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Physical Examination]]
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| [[Category:Disease state]]
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| [[Category:Signs and symptoms]]
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| [[Category:Overview complete]]
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