Pulmonary edema overview

Pulmonary edema Microchapters
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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").

Causes

Common causes of cardiogenic pulmonary edema are cardiomyopathy, congestive heart failure, coronary heart disease, aortic regurgitation, aortic stenosis. Common causes of noncardiogenic pulmonary edema are acute respiratory distress syndrome, high altitude pulmonary edema, pulmonary embolism.

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.

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

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.