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Pulmonary edema is swelling and/or fluid accumulation in the lungs. It leads to impaired gas exchange and may cause respiratory failure.
Signs and symptoms
Symptoms of pulmonary edema include difficulty breathing, coughing up blood, excessive sweating, anxiety and pale skin. If left untreated, it can lead to death, generally due to its main complication of hypoxia.
Diagnosis
Pulmonary edema is generally suspected due to findings in the medical history and physical examination: end-inspiratory crackles during auscultation (listening to the breathing through a stethoscope) can be due to pulmonary edema. The diagnosis is confirmed on X-ray of the lungs, which shows increased vascular filling and fluid in the alveolar walls.
Low oxygen saturation and disturbed arterial blood gas readings may strengthen the diagnosis and provide grounds for various forms of treatment.
Causes
Pulmonary edema is either due to direct damage to the tissue or as a result of inadequate functioning of the heart or circulatory system.
Cardiogenic causes:
- Heart failure
- Tachy- or bradyarrhythmias
- Severe heart attack
- Hypertensive crisis
- Excess body fluids, e.g. from kidney failure
- Pericardial effusion with tamponade
Non-cardiogenic causes, or ARDS (acute respiratory distress syndrome):
- Inhalation of toxic gases
- Multiple blood transfusions
- Severe infection
- Pulmonary contusion, i.e. high-energy trauma
- Multitrauma, i.e. severe car accident
- Neurogenic, i.e. cerebrovascular accident (CVA)
- Aspiration, i.e. gastric fluid or in case of drowning
- Certain types of medication
- Upper airway obstruction
- Reexpansion, i.e. postpneumonectomy or large volume thoracentesis
- Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation
- Lack of proper altitude acclimatization.
Therapy
When circulatory causes have led to pulmonary edema, treatment with nitrates (glyceryl trinitrate), positive pressure oxygen, and loop diuretics, such as furosemide or bumetanide, is the mainstay of therapy. Secondly, one can start with noninvasive ventilation. Other useful treatments include CPAP and oxygen.
There are no causal therapies for direct tissue damage; removal of the causes (e.g. treating an infection) is the most important measure.
See also
Reference
Pulmonology | Emergency medicine | Mountaineering
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"Pulmonary edema"