Pulmonary edema

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, anxietyand pale skin. If left untreated, it can lead to death, generally due to its main complication of acute respiratory distress syndrome.

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-rayof the lungs, which shows increased vascular filling and fluid in the alveolar walls.

Low oxygensaturation and disturbed arterial blood gasreadings 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 effusionwith 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. postpneumonectomyor 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 (nitroglycerine), positive pressure oxygen, and loop diuretics, such as furosemideor bumetanide, is the mainstay of therapy. Secondly, one can start with noninvasive ventilation. Other useful treatments include glyceryl trinitrate, CPAPand 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

• Flash pulmonary edema

Reference

• Medical Encyclopedia entryde:Höhenlungenödem

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It uses material from the http://en.wikipedia.org/wiki/Pulmonary+edema Wikipedia article Pulmonary edema.