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Pulmonary edema
Edema

File:Oedema.jpgEdema or Oedema , formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body....
 (American English), or oedema (British English, Greek ??d?ľa), is swelling and/or fluid accumulation in the lung
Lung

The lung is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart....
s. It leads to impaired gas exchange and may cause respiratory failure
Respiratory failure

The term respiratory failure, in medicine, is used to describe inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges....
. It is due to either failure of the heart
Heart

The heart is a muscle organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods....
 to remove fluid from the lung circulation ("cardiogenic pulmonary edema") or a direct injury to the lung parenchyma
Parenchyma

Parenchyma is a term used to describe a bulk of a substance. It is used in different ways in animals and in plants.The term is New Latin, from Greek language parenkhuma, visceral flesh, from parenkhein, to pour in beside : para-, beside + en-, in + khein, to pour....
 ("noncardiogenic pulmonary edema"). Treatment depends on the cause, but focuses on maximizing respiratory function and removing the cause.

toms of pulmonary edema include difficulty breathing, coughing up blood, excessive sweating
Diaphoresis

Diaphoresis is excessive Perspiration commonly associated with Shock and other medical emergency conditions.Diaphoretic is the state of perspiring profusely, or something that has the power to cause increased perspiration....
, anxiety
Anxiety

Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry....
, and pale skin
Pallor

Pallor is a reduced amount of oxyhemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, avoiding excessive exposure to sunlight, anemia or genetics....
.






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Pulmonary edema
Edema

File:Oedema.jpgEdema or Oedema , formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body....
 (American English), or oedema (British English, Greek ??d?ľa), is swelling and/or fluid accumulation in the lung
Lung

The lung is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart....
s. It leads to impaired gas exchange and may cause respiratory failure
Respiratory failure

The term respiratory failure, in medicine, is used to describe inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges....
. It is due to either failure of the heart
Heart

The heart is a muscle organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods....
 to remove fluid from the lung circulation ("cardiogenic pulmonary edema") or a direct injury to the lung parenchyma
Parenchyma

Parenchyma is a term used to describe a bulk of a substance. It is used in different ways in animals and in plants.The term is New Latin, from Greek language parenkhuma, visceral flesh, from parenkhein, to pour in beside : para-, beside + en-, in + khein, to pour....
 ("noncardiogenic pulmonary edema"). Treatment depends on the cause, but focuses on maximizing respiratory function and removing the cause.

Signs and symptoms

Symptoms of pulmonary edema include difficulty breathing, coughing up blood, excessive sweating
Diaphoresis

Diaphoresis is excessive Perspiration commonly associated with Shock and other medical emergency conditions.Diaphoretic is the state of perspiring profusely, or something that has the power to cause increased perspiration....
, anxiety
Anxiety

Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry....
, and pale skin
Pallor

Pallor is a reduced amount of oxyhemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, avoiding excessive exposure to sunlight, anemia or genetics....
. A classic sign of pulmonary edema is the production of pink frothy sputum
Sputum

Sputum is matter that is expectorated from the respiratory tract, such as mucus or phlegm, mixed with saliva, which can then be spat from the mouth....
. If left untreated, it can lead to coma and even death, in general, due to its main complication of hypoxia
Hypoxia (medical)

Hypoxia is a Pathology condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise....
. If pulmonary edema has been developing gradually, symptoms of fluid overload may be elicited. These include nocturia
Nocturia

Nocturia , also called nycturia , is the need to get up during the night in order to urinate, thus interrupting sleep. Its occurrence is more frequent in the elderly....
 (frequent urination at night), ankle edema
Edema

File:Oedema.jpgEdema or Oedema , formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body....
 (swelling of the legs, in general, of the "pitting" variety, wherein the skin is slow to return to normal when pressed upon), orthopnea (inability to lie down flat due to breathlessness), and paroxysmal nocturnal dyspnea
Paroxysmal nocturnal dyspnea

Cardiac asthma is a medical symptom, also known as paroxysmal dyspnea or paroxysmal nocturnal dyspnea .It is defined as sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing....
 (episodes of severe sudden breathlessness at night).

Diagnosis

In general, pulmonary edema is suspected due to findings in the medical history, such as previous cardiovascular disease, and physical examination
Physical examination

File:Reeve 978.jpgPhysical examination or clinical examination is the process by which a health care provider investigates the body of a patient for sign of disease....
: End-inspiratory crackles (sounds heard at the end of a deep breath) on auscultation (listening to the breathing through a stethoscope
Stethoscope

The stethoscope is a acoustic medicine device for auscultation, or listening to eth internal sounds of an animal body. It is stom often used to listen to heart sounds....
) are characteristic for pulmonary edema. The presence of a third heart sound
Third heart sound

The third heart sound or S3 is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds ....
 (S3) is predictive of cardiogenic pulmonary edema.

In general, blood tests are performed for electrolyte
Electrolyte

An electrolyte is any substance containing free ions that behaves as an electrical conductor medium. Because they generally consist of ions in solution, electrolytes are also known as ionic solutions, but molten electrolytes and solid electrolytes are also possible....
s (sodium, potassium) and markers of renal function
Renal function

Renal function, in nephrology, is an indication of the state of the kidney and its role in renal physiology. Glomerular filtration rate describes the flow rate of filtered fluid through the kidney....
 (creatinine, urea). Liver enzymes, inflammatory markers (usually C-reactive protein
C-reactive protein

C-reactive protein is a protein found in the blood in response to inflammation .CRP is produced by the liver and by fat cells . It is a member of the pentraxin family of proteins....
) and a complete blood count
Complete blood count

A complete blood count , also known as full blood count or full blood exam or blood panel, is a test requested by a physician or other medical professional that gives information about the cells in a patient's blood....
 as well as coagulation
Coagulation

Coagulation is a complex process by which blood forms clots. It is an important part of hemostasis , wherein a damaged blood vessel wall is covered by a platelet and fibrin-containing clot to stop hemorrhage and begin repair of the damaged vessel....
 studies (PT, aPTT) are typically requested. B-type natriuretic peptide
Brain natriuretic peptide

Brain natriuretic peptide , now known as B-type natriuretic peptide or GC-B, is a 32 amino acid polypeptide secreted by the Ventricle of the heart in response to excessive stretching of heart muscle cells ....
 (BNP) is available in many hospitals, especially in the US, sometimes even as a point-of-care test. Low levels of BNP (<100 pg/ml) make a cardiac cause very unlikely.

The diagnosis is confirmed on X-ray
X-ray

X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 10 to 0.01 nanometers, corresponding to frequency in the range 30 Hertz to 30 Hertz and energies in the range 120 Electron volt to 120 keV....
 of the lungs, which shows increased fluid in the alveolar walls. Kerley B lines
Kerley B lines

Kerley lines are a sign seen on chest x-rays with interstitial pulmonary edema. They are thin linear pulmonary opacities caused by fluid or cellular infiltration into the interstitium of the lungs....
, increased vascular filling, pleural effusion
Pleural effusion

Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during inhalation....
s, upper lobe diversion (increased blood flow to the higher parts of the lung) may be indicative of cardiogenic pulmonary edema, whereas patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema

Low oxygen saturation
Oxygen saturation

Oxygen saturation or Dissolved oxygen is a relative measure of the amount of oxygen that is dissolved or carried in a given medium. It can be measured with a dissolved oxygen probe such as an oxygen sensor or an optode in liquid media, usually water....
 and disturbed arterial blood gas
Arterial blood gas

An arterial blood gas is a blood test that is primarily performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood....
 readings may strengthen the diagnosis and provide grounds for various forms of treatment. If urgent echocardiography
Echocardiography

An echocardiogram, often referred to in the medical community as a cardiac ECHO or simply an ECHO, is a sonography of the heart. Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart....
 is available, this may strengthen the diagnosis, as well as identify valvular heart disease. In rare occasions, insertion of a Swan-Ganz catheter may be required to distinguish between the two main forms of pulmonary edema.

Causes

Pulmonary edema is either due to direct damage to the tissue or a result of inadequate functioning of the heart or circulatory system.

Cardiogenic

  • Congestive heart failure
    Congestive heart failure

    Heart failure is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs....
  • Severe heart attack
    Myocardial infarction

    Myocardial infarction , commonly known as a heart attack, occurs when the Blood flow to part of the heart is interrupted. This is most commonly due to occlusion of a coronary artery following the rupture of a Vulnerable plaque, which is an unstable collection of lipids and white blood cells in the wall of an artery....
     with left ventricular failure
  • Severe arrhythmias
    Cardiac arrhythmia

    Cardiac arrhythmia is a term for any of a large and heterogeneous group of conditions in which there is abnormal Electrical conduction system of the heart in the heart....
     (tachycardia/fast heartbeat or bradycardia/slow heartbeat)
  • Hypertensive crisis
  • Pericardial effusion
    Pericardial effusion

    Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation will lead to an increased intrapericardial pressure and this can negatively affect heart function....
     with tamponade
  • Fluid overload, e.g., from kidney failure
    Renal failure

    Renal failure or kidney failure is a situation in which the kidneys fail to function adequately. It is divided in acute and chronic forms; either form may be due to a large number of other medical problems....
     or intravenous therapy
    Intravenous therapy

    File:Infuuszakjes.jpgIntravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip....


Non-cardiogenic

May occur after upper airway obstruction, intravenous fluid overload, neurogenic causes (seizures, head trauma, strangulation, electrocution). Can also be seen with ARDS (acute respiratory distress syndrome
Acute respiratory distress syndrome

'Acute respiratory distress syndrome' , also known as 'respiratory distress syndrome' or 'adult respiratory distress syndrome' is a serious reaction to various forms of injuries to the lung....
):

Alveolar
  • Inhalation of toxic gases
  • Pulmonary contusion
    Pulmonary contusion

    A pulmonary contusion is a contusion of the lung, caused by chest trauma. As a result of damage to capillary, blood and other fluids accumulate in the lung tissue....
    , i.e., high-energy trauma
  • Aspiration
    Pulmonary aspiration

    In medicine, aspiration is the entry of secretions or foreign material into the Vertebrate trachea and lungs.The patient may either inhalation the material, or it may be blown into the lungs during positive pressure ventilation or CPR....
    , e.g., gastric fluid or in case of drowning
  • Reexpansion, i.e. post pneumonectomy
    Pneumonectomy

    A pneumonectomy is a surgery procedure to remove a lung. Removal of just one lobe of the lung is specifically referred to as a lobectomy , and that of a segment of the lung as a wedge resection ....
     or large volume thoracentesis
    Thoracentesis

    Thoracentesis is an invasive procedure to remove pleural effusion or pneumothorax from the pleural cavity for diagnostic or therapeutic purposes....
  • Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation
    Lung transplantation

    Lung transplantation is a surgical procedure in which a patient's diseased lungs are partially or totally replaced by lungs which come from a donor....
  • Immersion pulmonary edema
  • Multiple blood transfusion
    Blood transfusion

    Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. Blood transfusions can be life-saving in some situations, such as massive blood loss due to Physical trauma, or can be used to replace blood lost during surgery....
    s
  • Severe infection
    Infection

    An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....


Other/unknown
  • Multitrauma, e.g., severe car accident
  • Neurogenic, e.g., subarachnoid hemorrhage
    Subarachnoid hemorrhage

    A subarachnoid hemorrhage is bleeding into the subarachnoid space?the area between the arachnoid and the pia mater surrounding the brain. This may occur spontaneously, usually from a ruptured cerebral aneurysm, or may result from head injury....
  • Certain types of medication
  • Upper airway obstruction, i.e. negative pressure pulmonary edema
  • Arteriovenous malformation
    Arteriovenous malformation

    Arteriovenous malformation or AVM in the majority of cases is a congenital disorder consisting of a connection between veins and arteries, this pathology is universally known because of its occurrence in the central nervous system, but can appear in any location....
  • Ascent to high altitude occasionally causes high altitude pulmonary edema
    High Altitude Pulmonary Edema

    High altitude pulmonary edema is a life-threatening form of non-cardiogenic pulmonary edema that occurs in otherwise healthy mountaineers at altitudes above 2,500 meters ....
     (HAPE)


Therapy

Focus is initially on maintaining adequate oxygenation. This may happen with high-flow oxygen, noninvasive ventilation (either continuous positive airway pressure
Continuous positive airway pressure

Positive airway pressure is a method of mechanical ventilation used primarily in the treatment of sleep apnea, for which it was first developed....
 (CPAP) or variable positive airway pressure (VPAP)) or mechanical ventilation
Mechanical ventilation

In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous respiration .Mechanical ventilation is typically used after an invasive intubation, a procedure wherein an endotracheal tube or tracheostomy tube is inserted into the airway....
 in extreme cases.

When circulatory causes have led to pulmonary edema, treatment with intravenous nitrates (glyceryl trinitrate
Glyceryl trinitrate (pharmacology)

Glyceryl trinitrate is an alternate name for the chemical nitroglycerine, which has been used to treat Angina pectoris and heart failure since at least 1870....
), and loop diuretic
Loop diuretic

Loop diuretics are diuretics that act on the ascending loop of Henle in the kidney. They are primarily used in medicine to treat hypertension and edema often due to congestive heart failure or renal insufficiency....
s, such as furosemide
Furosemide

Furosemide or frusemide is a loop diuretic used in the treatment of congestive heart failure and edema. It is most commonly marketed by Sanofi-Aventis under the brand name Lasix....
 or bumetanide
Bumetanide

Bumetanide is a loop diuretic of the sulfamyl category to treat heart failure. It is often used in patients in whom high doses of furosemide are ineffective....
, is the mainstay of therapy. These improve both preload and afterload, and aid in improving cardiac function.

See also

  • High Altitude Pulmonary Edema
    High Altitude Pulmonary Edema

    High altitude pulmonary edema is a life-threatening form of non-cardiogenic pulmonary edema that occurs in otherwise healthy mountaineers at altitudes above 2,500 meters ....
  • Flash pulmonary edema
    Flash pulmonary edema

    In medicine, flash pulmonary edema , is rapid onset pulmonary edema. It is most often precipitated by acute myocardial infarction or mitral regurgitation, but can be caused by aortic regurgitation, heart failure, or almost any cause of elevated left ventricular filling pressures....