II. Definitions

  1. Pulmonary Edema
    1. Abnormal fluid accumulation in the extravascular lung compartments (lung parenchyma)

III. Pathophysiology

  1. See Generalized Edema
  2. Mechanisms
    1. Hydrostatic pressure gradient increased from intravascular to extravascular
      1. Cardiogenic Pulmonary Edema (increased left atrial pressure and pulmonary venous pressure)
    2. Osmotic pressure gradient decreased
      1. Malnutrition and Protein-losing conditions
    3. Capillary permeability increased
      1. Non-Cardiogenic Pulmonary Edema (lung parenchymal injury)
  3. Effects
    1. Decreased alveolar gas exchange
    2. Progressive Respiratory Failure

IV. Causes: Cardiogenic Pulmonary Edema (increased left atrial pressure)

  1. Atrial Outflow Obstruction (e.g. Mitral Stenosis, atrial Myxoma)
  2. Left ventricular outflow obstruction (Subaortic Stenosis, Aortic Stenosis, Aortic Coarctation)
  3. Cardiomyopathy (e.g. acute Myocarditis)
  4. Dysrhythmia (e.g. Atrial Fibrillation with rapid ventricular rate, third degree AV Block)
  5. Acute Myocardial Infarction
  6. Acute Decompensated Congestive Heart Failure
    1. Systolic Dysfunction
    2. Diastolic Dysfunction
    3. Left ventricular volume overload

VI. Findings

  1. General Findings
    1. Dyspnea
    2. Tachypnea
    3. Hypoxia
  2. Cardiogenic Pulmonary Edema Findings
    1. See Systolic Dysfunction
    2. Cough productive of pink frothy Sputum
    3. S3 Gallup
    4. Fine rales (small airway opening on inspiration)
    5. Jugular Venous Distention
    6. Peripheral Pitting Edema
  3. Non-Cardiogenic Pulmonary Edema Findings
    1. Evaluate for signs of underlying cause (e.g. infection source including Pneumonia)

VII. Differential Diagnosis

  1. Diffuse Pulmonary Hemorrhage
  2. Diffuse pulmonary infection

X. Imaging: Chest XRay

  1. See Chest XRay in Congestive Heart Failure
  2. Cardiogenic Pulmonary Edema Findings
    1. Mediastinal Widening
      1. Vascular pedicle measurement >53 mm
    2. Pleural Effusion
    3. Cardiomegaly
    4. Peribronchial cuffing
    5. Bronchovascular markings (Kerley B Lines)
  3. Non-Cardiogenic Pulmonary Edema Findings
    1. Batwing appearance of central lung vasculature at hilum
    2. Air Bronchograms
    3. Typically absent are cardiomegaly, Mediastinal Widening, Pleural Effusion

XII. References

  1. Malek (2020) Pulmonary Edema, StatPearls, accessed 12/29/2020
  2. Sureka (2015) J Family Med Prim Care 4(2):290 +PMID:25949989 [PubMed]

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Related Studies

Ontology: Pulmonary Edema (C0034063)

Definition (MSH) Excessive accumulation of extravascular fluid in the lung, an indication of a serious underlying disease or disorder. Pulmonary edema prevents efficient PULMONARY GAS EXCHANGE in the PULMONARY ALVEOLI, and can be life-threatening.
Definition (MSHCZE) Indikací závažného onemocnění nebo poruchy je nadměrné hromadění extravaskulární tekutiny v plicích. Plicní edém brání účinné výměně plynů (PLÍCE – VÝMĚNA PLYNŮ) v plicních sklípcích (PLICNÍ ALVEOLY) a může ohrožovat život.
Definition (NCI) Accumulation of fluid in the lung tissues causing disturbance of the gas exchange that may lead to respiratory failure. It is caused by direct injury to the lung parenchyma or congestive heart failure. The symptoms may appear suddenly or gradually. Suddenly appearing symptoms include difficulty breathing, feeling of suffocation, and coughing associated with frothy sputum. Gradually appearing symptoms include difficulty breathing while lying in bed, shortness of breath during activity, and weight gain (in patients with congestive heart failure).
Definition (NCI_NCI-GLOSS) A buildup of fluid in the alveoli (air spaces) in the lungs. This keeps oxygen from getting into the blood. Pulmonary edema is usually caused by heart problems, but it can also be caused by high blood pressure, pneumonia, certain toxins and medicines, or living at a high altitude. Symptoms include coughing, shortness of breath, and trouble exercising.
Definition (NCI_CTCAE) A disorder characterized by accumulation of fluid in the lung tissues that causes a disturbance of the gas exchange that may lead to respiratory failure.
Definition (CSP) extravascular accumulation of fluid in the pulmonary tissue and air spaces.
Concepts Disease or Syndrome (T047)
MSH D011654
ICD10 J81 , J81.1
SnomedCT 266408001, 196119001, 19242006
LNC LA7467-9
English Edema, Pulmonary, Edemas, Pulmonary, Lung, Wet, Lungs, Wet, Pulmonary Edema, Pulmonary Edemas, Wet Lung, Wet Lungs, LUNG EDEMA, EDEMA PULMONARY, LUNG OEDEMA, OEDEMA PULMONARY, PULMONARY OEDEMA, Pulmonary oedema NOS, Pulmonary edema NOS, EDEMA PULM, EDEMAS PULM, PULM EDEMAS, PULM EDEMA, pulmonary edema, pulmonary edema (diagnosis), Edema lung, Lung edema, Edema pulmonary, Lung oedema, Oedema pulmonary, Pulmonary Edema [Disease/Finding], lung edema, wet lung, lung oedema, Oedema;pulmonary, wet lungs, Pulmonary oedemas, Oedema - pulmonary NOS, Edema - pulmonary NOS, Oedema lung, Pulmonary edema NOS (disorder), PULMONARY EDEMA, EDEMA, PULMONARY, Pulmonary edema, Pulmonary oedema, Pulmonary edema (disorder), edema; lung, lung; edema, Pulmonary edema, NOS, pulmonary oedema, Edema;pulmonary
French OEDEME PULMONAIRE, Oedème des poumons, Oedème pulmonaire SAI, OAP (Oedème Aigu du Poumon), OEDEME DU POUMON, Oedèmes pulmonaires, Oedème pulmonaire, Oedème du poumon, Oedème aigu du poumon
Portuguese EDEMA PULMONAR, Edema pulmonar NE, EDEMA DO PULMAO, Edemas pulmonares, Edema pulmonar, Edema Pulmonar, Pulmão Úmido
Dutch longoedeem, pulmonaal oedeem NAO, oedeem long, long; oedeem, oedeem; long, longoedemen, pulmonaal oedeem, Longoedeem, Oedeem, long-, Wet lung
German Oedem der Lunge, Oedem pulmonal, pulmonales Oedem, Lungenoedem NNB, LUNGENOEDEM, OEDEM LUNGE, OEDEM PULMONAL, Lungenoedem, Lungenoedeme, Nasse Lunge, Flüssigkeitslunge, Lungenödem, Pulmonales Ödem
Italian Edema polmonare NAS, Edemi polmonari, Edema polmonare
Spanish Edema de pulmón, Edema pulmonar NEOM, EDEMA DE PULMON, PULMON, EDEMA, edema pulmonar, SAI (trastorno), edema pulmonar, SAI, edema pulmonar (trastorno), edema pulmonar, Edema pulmonar, Edemas pulmonares, Edema Pulmonar, Pulmón Húmedo
Japanese 肺水腫NOS, ハイスイシュ, ハイスイシュNOS, 肺水腫, 湿性肺, 水腫肺, 浮腫肺, 湿潤肺, 肺浮腫
Swedish Lungödem
Czech plíce - edém, Edém plic, Plicní edémy, Plicní edém NOS, Plicní edém, Edém plicní
Finnish Keuhkopöhö
Korean 폐부종
Polish Obrzęk płuc
Hungarian Tüdőoedema, Tüdővizenyő, Tüdő oedema, Pulmonális oedemák, Pulmonalis oedema, Tüdő-oedema, Tüdő oedemája, Pulmonalis oedema k.m.n.
Norwegian Lungeødem, Pulmonale ødemer, Pulmonalt ødem, Våt lunge, Ødem, pulmonal

Ontology: Non-cardiogenic pulmonary edema (C3241936)

Concepts Disease or Syndrome (T047)
SnomedCT 95437004, 67782005
Italian Edema polmonare non cardiogeno
German non-kardiogenes Pulmonaloedem, nicht-kardiogenes Lungenoedem
Japanese 非心原性肺水腫, ヒシンゲンセイハイスイシュ
English noncardiac pulmonary edema, noncardiac pulmonary edema (diagnosis), Non-cardiogenic pulm edema, Non-cardiogenic pulm oedema, non-cardiogenic pulmonary edema, Non-cardiogenic pulmonary edema, Non-cardiogenic pulmonary oedema, Non-cardiogenic pulmonary edema (disorder)
Czech Plicní edém nekardiogenní, Nekardiogenní plicní edém
Hungarian Nem-cardiogen pulmonalis oedema
Spanish edema pulmonar no cardiogénico (trastorno), edema pulmonar no cardiogénico, Edema de pulmón no cardiogénico
Portuguese Edema pulmonar não cardiogénico
Dutch longoedeem van niet-cardiale oorsprong
French Oedème pulmonaire non cardiogénique