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{{Pulmonary edema}}
{{Pulmonary edema}}
 
{{CMG}} {{AE}} {{FKH}}
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==Overview==
==Overview==
Pulmonary edema is due to either [[failure of the heart]] to remove fluid from the lung circulation ("cardiogenic pulmonary edema"), or due to a direct injury to the lung [[parenchyma]] or increased permeability or leakiness of the capillaries ("noncardiogenic pulmonary edema").<ref name=Ware>Ware LB, Matthay MA. Acute pulmonary edema. ''N Engl J Med'' 2005;353:2788-96. PMID 16382065.</ref>
Common causes of cardiogenic pulmonary edema are [[cardiomyopathy]], [[congestive heart failure]], [[Coronary heart disease|coronary heart diseas]]<nowiki/>e, [[aortic regurgitation]], [[aortic stenosis]]. Common causes of noncardiogenic pulmonary edema are [[acute respiratory distress syndrome]], high altitude pulmonary edema, [[Pulmonary Embolism|pulmonary embolism]].


==Differential diagnosis of Underlying Causes of Pulmonary Edema==
==Causes==
 
===Common Causes===
===Cardiogenic===
* [[Congestive heart failure]]
 
* [[Coronary Heart Disease]]
* Severe [[cardiac arrhythmia|arrhythmias]] ([[tachycardia]]/fast heartbeat or [[bradycardia]]/slow heartbeat)
* [[Arteriovenous malformation]]  
* [[Anomalous pulmonary venous return]]
* [[Aortic Regurgitation]]
* [[Aortic Regurgitation]]
* [[Aortic Stenosis]]
* [[Aortic Stenosis]]
* [[Arrhythmia]]
* [[Cardiomyopathy]]
* Congenita pulmonary venous stenosis
* [[Congestive heart failure]]
* [[Coronary Heart Disease]]
* [[Hypertensive crisis]]
* [[Left Heart Failure]]
* Left-to-Right Shunt
* [[Mitral Regurgitation]]
* [[Mitral Regurgitation]]
* [[Mitral Stenosis]]
* [[Mitral Stenosis]]
* [[Myocarditis]]
* [[Myocarditis]]
* [[Pericardial Disease]]. [[Pericardial effusion]] with tamponade
* [[Pericardial Disease]]
* ST elevation [[MI]] with [[left ventricular failure]]
 
===Non-cardiogenic===
This form is contiguous with ARDS ([[acute respiratory distress syndrome]]):
 
* Acute Bronchial [[Asthma]]
* [[Acute Renal Failure]]
* Bacterial toxins
* Blood [[Transfusions]]
* [[Burns]]
* Chronic [[mediastinitis]]
* Decompression sickness
* [[Disseminated Intravascular Coagulation]]
* [[Drowning]]
* [[Drugs]]
* Fibrotic/inflammatory disease
* Fluid overload, e.g. from [[renal failure|kidney failure]]
* Gastric content [[aspiration]]
* [[Goodpasture's Syndrome]]
* [[High altitude sickness]]. Ascent to high altitude occasionally causes [[high altitude pulmonary edema]] (HAPE)<ref>{{cite web | author=M Bates | title=High altitude pulmonary edema| url=http://www.altitude.org/hape_altitude.htm| publisher=Apex (Altitude Physiology Expeditions) | accessdate=2007-03-06}}</ref>
* [[Hyperhydration]]
* [[Hypoalbuminemia]] / Albumin deficiency
* [[Idiopathic Venoocclusive Disease]]
* Inhalation of toxic gases
* [[Infection]]
* [[Infection]]
* [[Leukemia]]
* [[Malaria]]
* Miliary [[Tuberculosis]]
* Neurogenic, e.g. [[subarachnoid hemorrhage]]
* [[Pheochromocytoma]]
* [[Pneumonia]]
* Pulmonary contusion, i.e. high-energy trauma
* [[Pulmonary Embolism]]
* Reexpansion, i.e. post [[pneumonectomy]] or large volume [[thoracentesis]]
* Reperfusion injury, i.e. postpulmonary thromboendartectomy or [[lung transplantation]]
* [[Sepsis]]
* [[Sepsis]]
* [[Shock]]
* [[Toxic Shock Syndrome]]
* Multi[[trauma]], e.g. motor vehicle accident
* Upper airway obstruction
* [[Uremia]]


===Complete Differential Diagnosis of the Causes of Pulmonary Edema===
===Causes by Organ System===
(By organ system)
{| style="width:70%; height:100px" border="1"
{|style="width:70%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |   
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |   
Severe [[cardiac arrhythmia|Arrhythmias]] ([[tachycardia]]/fast heartbeat or [[bradycardia]]/slow heartbeat),[[Arteriovenous malformation]],[[Anomalous pulmonary venous return]], [[Aortic Regurgitation]], [[Aortic Stenosis]], [[Arrhythmia]], [[Cardiomyopathy]], Congenital [[pulmonary vein]] stenosis, [[Congestive heart failure]], [[Coronary Heart Disease]], [[Hypertensive crisis]], [[Left Heart Failure]], Left-to-Right Shunt, [[Mitral Regurgitation]], [[Mitral Stenosis]], [[Myocarditis]], [[Pericardial Disease]], [[Pericardial effusion]] with tamponade, ST elevation [[MI]] with [[left ventricular failure]]
Severe [[cardiac arrhythmia|Arrhythmias]] ([[tachycardia]]/fast heartbeat or [[bradycardia]]/slow heartbeat),[[Arteriovenous malformation]],[[Anomalous pulmonary venous return]], [[Aortic Regurgitation]], [[Aortic Stenosis]], [[Arrhythmia]], [[Cardiomyopathy]], Congenital [[pulmonary vein]] stenosis, [[Congestive heart failure]], [[Coronary Heart Disease]], [[Hypertensive crisis]], [[Left Heart Failure]], Left-to-Right Shunt, [[Mitral Regurgitation]], [[Mitral Stenosis]], [[Myocarditis]], [[Pericardial Disease]], [[Pericardial effusion]] with tamponade, ST elevation [[MI]] with [[left ventricular failure]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Chemotherapy]]
[[Chemotherapy]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
A variety of [[Drugs]], particularly [[Chemotherapeutic agents]] such as anthracyclines
A variety of [[Drugs]], particularly [[Chemotherapeutic agents]] such as anthracyclines, [[Bosutinib]], [[Cytarabine]], [[Gadobenate Dimeglumine]],[[Gemcitabine]], [[Hydrochlorothiazide]], [[Meropenem]], [[Muromonab-CD3]], [[Oprelvekin]], [[Phenylephrine]], [[Pilocarpine]], [[Pramipexole]], [[Protamine sulfate]], [[prednisolone]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Upper airway obstruction]]
[[Upper airway obstruction]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Pheochromocytoma]]
[[Pheochromocytoma]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[High altitude sickness]]. Ascent to high altitude occasionally causes [[high altitude pulmonary edema]] (HAPE)<ref>{{cite web | author=M Bates | title=High altitude pulmonary edema| url=http://www.altitude.org/hape_altitude.htm| publisher=Apex (Altitude Physiology Expeditions) | accessdate=2007-03-06}}</ref>, Inhalation of toxic gases such as amonia, [[Water intoxication]]
[[High altitude sickness]]. Ascent to high altitude occasionally causes [[high altitude pulmonary edema]] (HAPE)<ref>{{cite web | author=M Bates | title=High altitude pulmonary edema| url=http://www.altitude.org/hape_altitude.htm| publisher=Apex (Altitude Physiology Expeditions) | accessdate=2007-03-06}}</ref>, Inhalation of toxic gases such as amonia, [[Water intoxication]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
Gastric content [[aspiration]]
Gastric content [[aspiration]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"|
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
Blood [[Transfusions]], [[Idiopathic Venoocclusive Disease]],  
Blood [[Transfusions]], [[Idiopathic Venoocclusive Disease]],  
[[Disseminated Intravascular Coagulation]], [[Leukemia]]
[[Disseminated Intravascular Coagulation]], [[Leukemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Hyperhydration]], Blood [[Transfusions]], [[High altitude sickness]]. Ascent to high altitude occasionally causes [[high altitude pulmonary edema]] (HAPE)<ref>{{cite web | author=M Bates | title=High altitude pulmonary edema| url=http://www.altitude.org/hape_altitude.htm| publisher=Apex (Altitude Physiology Expeditions) | accessdate=2007-03-06}}</ref>
[[Hyperhydration]], Blood [[Transfusions]], [[High altitude sickness]]. Ascent to high altitude occasionally causes [[high altitude pulmonary edema]] (HAPE)<ref>{{cite web | author=M Bates | title=High altitude pulmonary edema| url=http://www.altitude.org/hape_altitude.htm| publisher=Apex (Altitude Physiology Expeditions) | accessdate=2007-03-06}}</ref>
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
Bacterial toxins, [[Malaria]], Miliary [[Tuberculosis]], [[Sepsis]], [[Toxic Shock Syndrome]]
Bacterial toxins, [[Malaria]], Miliary [[Tuberculosis]], [[Sepsis]], [[Toxic Shock Syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
Neurogenic, e.g. [[Subarachnoid hemorrhage]]
Neurogenic, e.g. [[Subarachnoid hemorrhage]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Hypoalbuminemia]] / [[Albumin]] deficiency, [[Water intoxication]]
[[Hypoalbuminemia]] / [[Albumin]] deficiency, [[Water intoxication]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Toxic Shock Syndrome]]
[[Toxic Shock Syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Chemotherapy]]
[[Chemotherapy]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Chemotherapy]], [[Water intoxication]]
[[Chemotherapy]], [[Water intoxication]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Psychogenic polydipsia]] with [[hyperhydration]], [[Water intoxication]]
[[Psychogenic polydipsia]] with [[hyperhydration]], [[Water intoxication]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
Acute Bronchial [[Asthma]], [[Drowning]], Gastric content [[aspiration]], [[Mediastinitis]],[[Pneumonia]], [[Pulmonary contusion]], [[Pulmonary embolism]], Reexpansion, i.e. post [[pneumonectomy]] or large volume [[thoracentesis]], Reperfusion injury, i.e. postpulmonary thromboendartectomy or [[lung transplantation]], [[Upper airway obstruction]]
Acute Bronchial [[Asthma]], [[Drowning]], Gastric content [[aspiration]], [[Mediastinitis]],[[Pneumonia]], [[Pulmonary contusion]], [[Pulmonary embolism]], Reexpansion, i.e. post [[pneumonectomy]] or large volume [[thoracentesis]], Reperfusion injury, i.e. postpulmonary thromboendartectomy or [[lung transplantation]], [[Upper airway obstruction]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Acute Renal Failure]], [[Uremia]]
[[Acute Renal Failure]], [[Uremia]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Goodpasture's Syndrome]]
[[Goodpasture's Syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"|
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Drowning]], [[Burns]], Inhalation of toxic gases, [[Pulmonary contusion]], [[Trauma]]
[[Drowning]], [[Burns]], Inhalation of toxic gases, [[Pulmonary contusion]], [[Trauma]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Acute Renal Failure]], [[Uremia]]
[[Acute Renal Failure]], [[Uremia]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"|   
| bgcolor="Beige" |   
[[Decompression sickness]], [[Shock]]
[[Decompression sickness]], [[Shock]]
|-
|-
|}
|}
===Causes in Alphabetical Order===
====Cardiogenic====
* Severe [[cardiac arrhythmia|arrhythmias]] ([[tachycardia]]/fast heartbeat or [[bradycardia]]/slow heartbeat)
* [[Arteriovenous malformation]]
* [[Anomalous pulmonary venous return]]
* [[Aortic Regurgitation]]
* [[Aortic Stenosis]]
* [[Arrhythmia]]
* [[Cardiomyopathy]]
* Congenita pulmonary venous stenosis
* [[Congestive heart failure]]
* [[Coronary Heart Disease]]
*[[Cytarabine]]
* [[Hypertensive crisis]]
* [[Left Heart Failure]]
* Left-to-Right Shunt
* [[Mitral Regurgitation]]
* [[Mitral Stenosis]]
* [[Myocarditis]]
* [[Pericardial Disease]]
* [[Pericardial effusion]] with tamponade
* ST elevation [[MI]] with [[left ventricular failure]]
====Non-cardiogenic====
This form is contiguous with ARDS ([[acute respiratory distress syndrome]]):
* Acute Bronchial [[Asthma]]
* [[Acute Renal Failure]]
* Bacterial toxins
* Blood [[Transfusions]]
* [[Burns]]
* Chronic [[mediastinitis]]
* Decompression sickness
* [[Disseminated Intravascular Coagulation]]
* [[Drowning]]
* [[Drugs]]- [[Cytomegalovirus immune globulin]]
* Fibrotic/inflammatory disease
* Fluid overload, e.g. from [[renal failure|kidney failure]]
* Gastric content [[aspiration]]
* [[Goodpasture's Syndrome]]
* [[High altitude sickness]]. Ascent to high altitude occasionally causes [[high altitude pulmonary edema]] (HAPE)<ref>{{cite web | author=M Bates | title=High altitude pulmonary edema| url=http://www.altitude.org/hape_altitude.htm| publisher=Apex (Altitude Physiology Expeditions) | accessdate=2007-03-06}}</ref>
* [[Hyperhydration]]
* [[Hypoalbuminemia]] / Albumin deficiency
* [[Idiopathic Venoocclusive Disease]]
* Inhalation of toxic gases
* [[Infection]]
* [[Leukemia]]
* [[Malaria]]
* Miliary [[Tuberculosis]]
* Neurogenic, e.g. [[subarachnoid hemorrhage]]
*[[Oprelvekin]]
* [[Pheochromocytoma]]
* [[Pneumonia]]
* Pulmonary contusion, i.e. high-energy trauma
* [[Pulmonary Embolism]]
* Reexpansion, i.e. post [[pneumonectomy]] or large volume [[thoracentesis]]
* Reperfusion injury, i.e. postpulmonary thromboendartectomy or [[lung transplantation]]
* [[Sepsis]]
* [[Shock]]
* [[Toxic Shock Syndrome]]
* Multi[[trauma]], e.g. motor vehicle accident
* Upper airway obstruction
* [[Uremia]]


==References==
==References==
{{Reflist|2}}
{{reflist|2}}


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Latest revision as of 17:16, 14 March 2018

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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

Common causes of cardiogenic pulmonary edema are cardiomyopathy, congestive heart failure, coronary heart disease, aortic regurgitation, aortic stenosis. Common causes of noncardiogenic pulmonary edema are acute respiratory distress syndrome, high altitude pulmonary edema, pulmonary embolism.

Causes

Common Causes

Causes by Organ System

Cardiovascular

Severe Arrhythmias (tachycardia/fast heartbeat or bradycardia/slow heartbeat),Arteriovenous malformation,Anomalous pulmonary venous return, Aortic Regurgitation, Aortic Stenosis, Arrhythmia, Cardiomyopathy, Congenital pulmonary vein stenosis, Congestive heart failure, Coronary Heart Disease, Hypertensive crisis, Left Heart Failure, Left-to-Right Shunt, Mitral Regurgitation, Mitral Stenosis, Myocarditis, Pericardial Disease, Pericardial effusion with tamponade, ST elevation MI with left ventricular failure

Chemical / poisoning

Chemotherapy

Dermatologic No underlying causes
Drug Side Effect

A variety of Drugs, particularly Chemotherapeutic agents such as anthracyclines, Bosutinib, Cytarabine, Gadobenate Dimeglumine,Gemcitabine, Hydrochlorothiazide, Meropenem, Muromonab-CD3, Oprelvekin, Phenylephrine, Pilocarpine, Pramipexole, Protamine sulfate, prednisolone

Ear Nose Throat

Upper airway obstruction

Endocrine

Pheochromocytoma

Environmental

High altitude sickness. Ascent to high altitude occasionally causes high altitude pulmonary edema (HAPE)[1], Inhalation of toxic gases such as amonia, Water intoxication

Gastroenterologic

Gastric content aspiration

Genetic No underlying causes
Hematologic

Blood Transfusions, Idiopathic Venoocclusive Disease, Disseminated Intravascular Coagulation, Leukemia

Iatrogenic

Hyperhydration, Blood Transfusions, High altitude sickness. Ascent to high altitude occasionally causes high altitude pulmonary edema (HAPE)[2]

Infectious Disease

Bacterial toxins, Malaria, Miliary Tuberculosis, Sepsis, Toxic Shock Syndrome

Musculoskeletal / Ortho No underlying causes
Neurologic

Neurogenic, e.g. Subarachnoid hemorrhage

Nutritional / Metabolic

Hypoalbuminemia / Albumin deficiency, Water intoxication

Obstetric/Gynecologic

Toxic Shock Syndrome

Oncologic

Chemotherapy

Opthalmologic No underlying causes
Overdose / Toxicity

Chemotherapy, Water intoxication

Psychiatric

Psychogenic polydipsia with hyperhydration, Water intoxication

Pulmonary

Acute Bronchial Asthma, Drowning, Gastric content aspiration, Mediastinitis,Pneumonia, Pulmonary contusion, Pulmonary embolism, Reexpansion, i.e. post pneumonectomy or large volume thoracentesis, Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation, Upper airway obstruction

Renal / Electrolyte

Acute Renal Failure, Uremia

Rheum / Immune / Allergy

Goodpasture's Syndrome

Sexual No underlying causes
Trauma

Drowning, Burns, Inhalation of toxic gases, Pulmonary contusion, Trauma

Urologic

Acute Renal Failure, Uremia

Miscellaneous

Decompression sickness, Shock

Causes in Alphabetical Order

Cardiogenic

Non-cardiogenic

This form is contiguous with ARDS (acute respiratory distress syndrome):

References

  1. ↑ M Bates. "High altitude pulmonary edema". Apex (Altitude Physiology Expeditions). Retrieved 2007-03-06.
  2. ↑ M Bates. "High altitude pulmonary edema". Apex (Altitude Physiology Expeditions). Retrieved 2007-03-06.
  3. ↑ M Bates. "High altitude pulmonary edema". Apex (Altitude Physiology Expeditions). Retrieved 2007-03-06.


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