Pulmonary edema physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Overview

Patients with pulmonary edema usually appear agitated. Physical examination of patients with pulmonary edema is usually remarkable for dyspnea, tachypnea. Patients with cardiogenic pulmonary edema often have an abnormal cardiac examination. Patients with noncardiogenic edema often have warm extremities, even in the absence of sepsis, whereas patients with cardiogenic edema and poor cardiac output usually have cool extremities.

Physical Examination

Physical examination of patients with pulmonary edema is usually remarkable for:

•  Dyspnea

• Tachypnea

Differentiation of cardiogenic pulmonary edema and noncardiogenic pulmonary edema

Clinical examination
Cardiogenic pulmonary edema	Low flow state=cool periphery	S3 gallop/cardiomegaly	Jugular venous distention	Crackles(wet)
Noncardiogenic pulmonary edema	High flow state=warm periphery	No gallop	No jugular venous distention	Crackles(dry)

Appearance of the Patient

• Patients with pulmonary edema usually appear :
  • Anxious
  • Decrease in level of alertness (consciousness)
  • Inability to speak in full sentences

Vital Signs

• Hyperthermia may be present
• Tachycardia with regular pulse
• Tachypnea
• High/low blood pressure with normal pulse pressure

Skin

• Pallor
• cold and clammy in cardiogenic pulmonary edema
• Warm extremities in noncardiogenic pulmonary edema
• livedo reticularis
• Peripheral cyanosis may be present

HEENT

• Nasal flaring
• Dilated alae nasi

Neck

• Neck examination of patients with pulmonary edema is usually normal.

Lungs

• Wheezing may be present
• Prolonged expiratory phase 
• Retraction of intercostal muscle
• Use of accessory muscles of respiration

Heart

• A third heart sound (S3) may be present
• Pulsus alternans
• Alternating weak and strong pulse, may be a sign of left ventricular failure in CHF as underlying cause of cardiogenic pulmonary edema
• Heart sounds with presence of S3, S4, and harsh murmur
• JVD

Abdomen

• Abdomen examination of patients with pulmonary edema is usually normal.

Back

• Back examination of patients with pulmonary edema is usually normal.

Genitourinary

• Genitourinary examination of patients with pulmonary edema is usually normal.

Neuromuscular

• Neurologic examination may reveal focal signs as neurogenic causes of pulmonary edema.

Extremities

• Peripheral edema of extremities