Pulmonary Edema

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Contents 1 More Specific Terms 2 Introduction 3 Etiology 4 Pathology 5 Management 6 More General Terms 7 References

More Specific Terms

• cardiogenic pulmonary edema (CPE)
• high-altitude pulmonary edema

Introduction

• Pulmonary edema ( PE) is a condition, usually acute, but sometimes chronic, where fluid builds up in the lungs. This often occurs as a response to left ventricular failure in ischemic heart disease, hypertension, or aortic valve disease ( cardiogenic pulmonary edema).

Etiology

• imbalance of starling forces

• left ventricular failure
• obstruction of flow through the mitral valve

• mitral stenosis
• atrial myxoma

• pulmonary veno-occlusive disease (rare)
• pulmonary artery hypertension (overperfusion PE)
• hypoalbuminemia
• asthma

• altered alveolar- capillary membrane permeability, adult respiratory distress syndrome ( ARDS)

• infectious pneumonia
• inhaled toxins
• circulating vascular toxins

• snake venom
• bacterial endotoxin

• aspiration of acidic gastric acid contents
• acute radiation pneumonitis
• endogenous vasoactive substances ( histamines, kinins)
• disseminated intravascular coagulation
• hypersensitivity pneumonitis
• shock in associated with non- thoracic trauma
• acute hemorrhagic pancreatitis

• lymphatic insufficiency

• post lung transplantation
• lymphangtic carcinomatosis
• fibrosing lymphangitis ( silicosis)

• poorly understood causes

• high-altitude pulmonary edema
• neurogenic pulmonary edema
• pulmonary embolism
• eclampsia
• post cardioversion
• post anesthesia
• post cardiopulmonary bypass

• pharmacologic causes:

• contrast media
• opiates

• heroin
• methadone
• morphine
• propoxyphene

• nitrofurantoin
• propoxyphene
• non-steroidal anti-inflammatory drugs ( NSAIDs)

• aspirin
• phenylbutazone
• oxyphenbutazone

• leukoagglutinins in blood products
• chlordiazepoxide ( Librium)
• ethchlorvynol ( Placidyl)
• interleukin-2

Pathology

• pulmonary capillary pressure exceeds forces which maintain fluid in the intravascular space:

• serum oncotic pressure
• interstitial hydrostatic pressure

• altered alveolar-capillary membrane permeability
• accumulation of fluid in the pulmonary interstitium

• leakage of fluid into alveolar space
• impairment of gas exchange

Management

• (see cardiogenic pulmonary edema)

More General Terms

• edema (swelling)

References

1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 130
2. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 761, 762, 763
4. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 173
5. Hubble MW et al, Effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema. Prehosp Emerg Care 2006, 10:430 PMID: [1]
6. PubMed Search PubMed search: [la&tool=anvita&email=s.ball@anvita.info]

pulmonary edema (pulmonary congestion, PE)