II. Definitions
- Pulmonary Edema
- Abnormal fluid accumulation in the extravascular lung compartments (lung parenchyma)
III. Pathophysiology
- See Generalized Edema
- Mechanisms
- Hydrostatic pressure gradient increased from intravascular to extravascular
- Cardiogenic Pulmonary Edema (increased left atrial pressure and pulmonary venous pressure)
- Osmotic pressure gradient decreased
- Malnutrition and Protein-losing conditions
- Capillary permeability increased
- Non-Cardiogenic Pulmonary Edema (lung parenchymal injury)
- Hydrostatic pressure gradient increased from intravascular to extravascular
- Effects
- Decreased alveolar gas exchange
- Progressive Respiratory Failure
IV. Causes: Cardiogenic Pulmonary Edema (increased left atrial pressure)
- Atrial Outflow Obstruction (e.g. Mitral Stenosis, atrial Myxoma)
- Left ventricular outflow obstruction (Subaortic Stenosis, Aortic Stenosis, Aortic Coarctation)
- Cardiomyopathy (e.g. acute Myocarditis)
- Dysrhythmia (e.g. Atrial Fibrillation with Rapid Ventricular Rate, third degree AV Block)
- Acute Myocardial Infarction
-
Acute Decompensated Congestive Heart Failure
- Systolic Dysfunction
- Diastolic Dysfunction
- Left ventricular volume overload
V. Causes: Non-Cardiogenic Pulmonary Edema (lung parenchymal injury with capillary leak)
- Drowning
- Fluid Overload (e.g. Massive Blood Transfusion)
- Foreign Body Aspiration
- Inhalation Injury
- Acute Kidney Injury
- Anaphylaxis
- Sepsis
- Acute Pancreatitis
- Adult Respiratory Distress Syndrome
- Neurogenic Pulmonary Edema (Cerebrovascular Accident)
- Transfusion-Related Acute Lung Injury (TRALI)
- Negative Pressure Pulmonary Edema
VI. Findings
- General Findings
-
Cardiogenic Pulmonary Edema Findings
- See Systolic Dysfunction
- Cough productive of pink frothy Sputum
- S3 Gallup
- Fine rales (small airway opening on inspiration)
- Jugular Venous Distention
- Peripheral Pitting Edema
- Non-Cardiogenic Pulmonary Edema Findings
- Evaluate for signs of underlying cause (e.g. infection source including Pneumonia)
VII. Differential Diagnosis
- Diffuse Pulmonary Hemorrhage
- Diffuse pulmonary infection
VIII. Labs
IX. Imaging: Ultrasound
X. Imaging: Chest XRay
- See Chest XRay in Congestive Heart Failure
-
Cardiogenic Pulmonary Edema Findings
- Mediastinal Widening
- Vascular pedicle measurement >53 mm
- Pleural Effusion
- Cardiomegaly
- Peribronchial cuffing
- Bronchovascular markings (Kerley B Lines)
- Mediastinal Widening
- Non-Cardiogenic Pulmonary Edema Findings
- Batwing appearance of central lung vasculature at hilum
- Air Bronchograms
- Typically absent are cardiomegaly, Mediastinal Widening, Pleural Effusion
XI. Management
XII. References
- Malek (2020) Pulmonary Edema, StatPearls, accessed 12/29/2020
- Sureka (2015) J Family Med Prim Care 4(2):290 +PMID:25949989 [PubMed]