Pulmonary edema pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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").

Pathophysiology

It is understood that pulmonary edema is the result of abnormal increase in extravascular lung water (EVLW). Pulmonary edema is caused by either :

• Imbalance of starling force:
  • Increase pulmonary capillary pressure
    • Left ventricular failure
    • Volume overload
  • decrease plasma oncotic pressure
    • Hypoalbuminemia
  • increase negative interstitial pressure

• Altered alveolar-capillary membrane permeability

• Lymphatic insufficiency

• Unknown or incompletely understood

depends on the inciting mechanismThe flux of flui

d across the capillary level is controlled by a balance between hydrostatic pressure and osmotic pressure gradients between the capillaries and interstitial space that can be calculated via Starling equation:

Jv = Net rate of capillary filtration

Kfc = Capillary filtration coefficient

Pc = Capillary hydrostatic pressure

Pi = Interstitial hydrostatic pressure

σ = Osmotic reflection coefficient

πp = Plasma oncotic pressure

πi = Interstitial oncotic pressure

Gross Pathology

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

• 

  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).

• 

  This is a gross photograph of lung demonstrating acute pulmonary congestion and edema. A frothy exudate fills the bronchus (arrow).

• 

  This gross photograph demonstrates the frothy exudate that is being extruded from the lung tissue.

Microscopic Pathology

• 

  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.

• 

  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.

• 

  This is a higher-power photomicrograph showing edema-filled alveoli in the right portion of this section (arrows).

• 

  This high-power photomicrograph illustrates the edema fluid within the alveoli (1) and the congestion (RBCs) in the alveolar capillaries (arrows).