Pulmonary edema: Difference between revisions

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__NOTOC__
{{Infobox_Disease |
{{Infobox_Disease |
   Name          = Pulmonary edema |
   Name          = Pulmonary edema |
   Image          = pulmonary edema.gif|
   Image          = pulmonary edema.gif|
   Caption        = Chest x-ray showing pulmonary edema|
   Caption        = Chest x-ray showing pulmonary edema|
  DiseasesDB    = 11017 |
  ICD10          = {{ICD10|J|81||j|80}} |
  ICD9          = {{ICD9|514}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 000140 |
  eMedicineSubj  = |
  eMedicineTopic = |
  eMedicine_mult = |
}}
}}
{{Template:Pulmonary edema}}
{{Template:Pulmonary edema}}
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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{FKH}}


==Natural History, Complications and Prognosis==
{{SK}} Pulmonary edema; lung edema; lung congestion; lung water; pulmonary congestion
If left untreated, acute pulmonary edema can lead to [[coma]] and even death, generally due to its main complication of [[Hypoxia (medical)|hypoxia]].


==Echocardiography==
==[[Pulmonary edema overview|Overview]]==
[[Echocardiography]] is useful in confirming a cardiac or no-cardiac cause of pulmonary edema.  Among cardiac causes, echocardiography can identify if systolic or [[diastolic dysfunction]] is present.  Echocardiography is useful in identify if focal segment wall motion abnormalities are present which would suggest ischemia or [[myocardial infarction]] as an underlying cause. If there is a global impairment of left ventricular function, then this suggests a [[cardiomyopathy]] may be present. Echocardiography may identify the presence and severity of valvular causes of pulmonary edema including [[aortic stenosis]], [[aortic insufficiency]], [[mitral stenosis]]. [[mitral insufficiency]], and [[hypertrophic cardiomyopathy]].


==Cardiac Catheterization==
==[[Pulmonary edema historical perspective|Historical Perspective]]==
Insertion of a [[pulmonary arterial catheter]] (a.k.a. a [[Swan-Ganz catheter]]) may be required to distinguish between the two main forms of pulmonary edema and to help guide management<ref name=Ware/>.  In patients with cardiogenic pulmonary edema the pulmonary artery pressure will be elevated. Among patients with non-cardiogenic pulmonary edema the wedge pressure will not be elevated.


==Treatment==
==[[Pulmonary edema classification|Classification]]==
''See also the chapter on [[congestive heart failure]]''.


===Acute Pulmonary Edema===
==[[Pulmonary edema pathophysiology|Pathophysiology]]==
In patients with acute pulmonary edema, the goal is to reduce both [[preload]] and [[afterload]] and to [[diurese]] the patient. Intravenous  nitroglycerin can be used to reduce both the preload and afterload. Diuretics such as [[furosemide]] or [[bumetanide]] can be used to reduce volume overload. The dose that the patient is on chronically should be doubled and administered intravenously in the setting of flash pulmonary edema.  [[Morphine sulfate]] may be helpful in reducing the drive to breathe, improving patient comfort, and reducing the [[preload]].


Oxygen therapy is required to minimize [[cyanosis]] and to maintain adequate oxygenation. High-flow oxygen, noninvasive ventilation (either [[continuous positive airway pressure]] (CPAP) or variable positive airway pressure (VPAP) may be effective<ref>Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. ''JAMA'' 2005;294:3124-30. PMID 16380593.</ref><ref>Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. ''Lancet'' 2006;367(9517):1155-63. PMID 16616558.</ref>).  If the simple measures are not effective then [[mechanical ventilation]] may be required.
==[[Pulmonary edema causes|Causes]]==


Treatment should also be directed at managing the underlying cause of an episode of acute pulmonary edema.  This would include managing as [[acute myocardial infarction]], [[mitral regurgitation]], [[aortic regurgitation]], or any other condition that causes an increase in left ventricular filling pressures.
==[[Pulmonary edema differential diagnosis|Differentiating Pulmonary Edema from other Diseases]]==


===Chronic Pulmonary Edema===
==[[Pulmonary edema epidemiology and demographics|Epidemiology and Demographics]]==
Reoccurrence of FPE is thought to be associated with [[hypertension]]<ref>Kramer K, Kirkman P, Kitzman D, Little WC. Flash pulmonary edema: association with hypertension and reoccurrence despite coronary revascularization. Am Heart J. 2000 Sep;140(3):451-5. PMID 10966547.</ref> and may signify [[renal artery stenosis]].<ref>Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, Silane MF, Laragh JH. Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. ''Lancet'' 1988;2(8610):551-2. PMID 2900930.</ref> Prevention of reoccurrence is based on managing hypertension, coronary artery disease, renovascular hypertension, and heart failure.


==[[Pulmonary edema risk factors|Risk Factors]]==


==Pathology and Case Report==
==[[Pulmonary edema natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


===Clinical Summary===
==Diagnosis==


A 69-year-old male with well-controlled Type I [[diabetes mellitus]] (insulin-dependent) presented with upper abdominal and lower [[chest pain]] of four hours duration and accompanied by [[shortness of breath]] and [[diaphoresis]].
[[Pulmonary edema history and symptoms|History and Symptoms]] | [[Pulmonary edema physical examination|Physical Examination]] | [[Pulmonary edema laboratory tests|Laboratory Findings]] |  [[Pulmonary edema chest x ray|X Ray]] | [[Pulmonary edema CT|CT]] | [[Pulmonary edema echocardiography|Echocardiography]] | [[Pulmonary edema other diagnostic studies|Other Diagnostic Studies]]


An [[electrocardiogram]] revealed multiple [[premature ventricular contraction]]s (PVCs).
==Treatment==
 
The hospital course was characterized by recurrent [[pulmonary edema]] and [[oliguria]].


The terminal event was [[cardiac arrest]].
[[Pulmonary edema medical therapy|Medical Therapy]] | | [[Pulmonary edema surgery|Surgery]] | [[Pulmonary edema primary prevention|Primary Prevention]] | [[Pulmonary edema secondary prevention|Secondary Prevention]] | [[Pulmonary edema cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pulmonary edema future or investigational therapies|Future or Investigational Therapies]]


===Autopsy Study===
==Case Studies==


Significant findings at postmortem examination were old and recent [[myocardial infarction]]s and evidence of [[congestive heart failure]].
[[Pulmonary edema case study one|Case #1]]


The right and left lungs weighed 950 grams and 750 grams, respectively, and were reddish-brown.
==Related Chapters==
 
===Histopathological Findings===
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<div align="left">
<gallery heights="125" widths="125">
Image:Pulmonary edema case 1.1.jpg|This is a gross photograph of lungs that are distended and red. The reddish coloration of the tissue is due to congestion. Some normal pink lung tissue is seen at the edges of the lungs (arrows).
Image:Pulmonary edema case 1.2.jpg|This is a gross photograph of lung demonstrating acute pulmonary congestion and edema. A frothy exudate fills the bronchus (arrow).
Image:Pulmonary edema case 1.3.jpg|This gross photograph demonstrates the frothy exudate that is being extruded from the lung tissue.
</gallery>
</div>
 
 
<div align="left">
<gallery heights="125" widths="125">
Image:Pulmonary edema case 1.4.jpg|This is a low-power photomicrograph of lung from this case. The lung section has a pale-red color indicating proteinaceous material within the lung.
Image:Pulmonary edema case 1.5.jpg|This is a higher-power photomicrograph of lung. The edema fluid within the alveoli is visible at this higher magnification (arrows). The thickened pleura (1) is on the left.
</gallery>
</div>
 
 
<div align="left">
<gallery heights="125" widths="125">
Image:Pulmonary edema case 1.6.jpg|This is a higher-power photomicrograph showing edema-filled alveoli in the right portion of this section (arrows).
Image:Pulmonary edema case 1.7.jpg|This high-power photomicrograph illustrates the edema fluid within the alveoli (1) and the congestion (RBCs) in the alveolar capillaries (arrows).
</gallery>
</div>
 
==References==
{{reflist|2}}
 
==See also==
*[[High Altitude Pulmonary Edema]]
*[[High Altitude Pulmonary Edema]]
*[[Myocardial infarction]]
*[[Myocardial infarction]]
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{{Respiratory pathology}}
{{Respiratory pathology}}


[[bs:Akutni edem pluća]]
 
[[de:Höhenlungenödem]]
[[es:Edema agudo de pulmón]]
[[es:Edema agudo de pulmón]]
[[ko:폐부종]]
[[it:Edema polmonare acuto]]
[[he:בצקת ריאות]]
[[nl:Longoedeem]]
[[new:पल्मोनरी इडिमा]]
[[ja:肺水腫]]
[[ja:肺水腫]]
[[pt:Edema pulmonar]]
[[pt:Edema pulmonar]]
[[sr:Акутни едем плућа]]
[[fi:Keuhkoödeema]]
[[sv:Lungödem]]
[[pl:Obrzęk płuc]]
[[pl:Obrzęk płuc]]
[[tr:Akciğer ödemi]]
[[tr:Akciğer ödemi]]
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[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Mountaineering]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Physical Examination]]
 
[[Category:Disease state]]
[[Category:Signs and symptoms]]
[[Category:Overview complete]]


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Latest revision as of 19:12, 6 March 2018

Pulmonary edema
Chest x-ray showing pulmonary edema

Pulmonary edema Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pulmonary Edema from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

Electrocardiography

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventional Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pulmonary edema On the Web

Most recent articles

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US National Guidelines Clearinghouse

NICE Guidance

FDA on Pulmonary edema

CDC on Pulmonary edema

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Blogs on Pulmonary edema

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Risk calculators and risk factors for Pulmonary edema

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Farnaz Khalighinejad, MD [2]

Synonyms and keywords: Pulmonary edema; lung edema; lung congestion; lung water; pulmonary congestion

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pulmonary Edema from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | CT | Echocardiography | Other Diagnostic Studies

Treatment

Medical Therapy | | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

Template:Respiratory pathology


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