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Pulmonary Edema
Aka: Pulmonary Edema, Non-Cardiogenic Pulmonary Edema
- See Also
- Generalized Edema
- Cardiogenic Shock (Cardiogenic Pulmonary Edema)
- Toxin Induced Pulmonary Edema
- High Altitude Pulmonary Edema (HAPE)
- Definitions
- Pulmonary Edema
- Abnormal fluid accumulation in the extravascular lung compartments (lung parenchyma)
- 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)
- Effects
- Decreased alveolar gas exchange
- Progressive Respiratory Failure
- 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
- 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)
- Findings
- General Findings
- Dyspnea
- Tachypnea
- Hypoxia
- 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)
- Differential Diagnosis
- Diffuse Pulmonary Hemorrhage
- Diffuse pulmonary infection
- Labs
- See Acute Pulmonary Edema Management
- See Systolic Dysfunction
- See Generalized Edema
- Imaging: Ultrasound
- See Echocardiogram in CHF
- See Bedside Lung Ultrasound in Emergency (Blue Protocol)
- See Rapid Ultrasound in Shock (RUSH Exam)
- See Inferior Vena Cava Ultrasound for Volume Status
- 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)
- Non-Cardiogenic Pulmonary Edema Findings
- Batwing appearance of central lung vasculature at hilum
- Air Bronchograms
- Typically absent are cardiomegaly, Mediastinal Widening, Pleural Effusion
- Management
- See Acute Pulmonary Edema Management
- References
- Malek (2020) Pulmonary Edema, StatPearls, accessed 12/29/2020
- Sureka (2015) J Family Med Prim Care 4(2):290 +PMID:25949989 [PubMed]