Pulmonary Edema

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Author:
jknell
ID:
198448
Filename:
Pulmonary Edema
Updated:
2013-02-06 17:30:15
Tags:
Pulmonary II
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Description:
interstitial edema, alveolar edema
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  1. Pulmonary Edema
    definition, phases
    Abnormal accumulation of fluid in the extravascular spaces and tissues of the lung

    • 1. Interstitial edema
    • 2. Alveolar edema

  2. Pulmonary edema
    Pathology
    • Pathology
    • -Perivascular cuff of edema around pulmonary vessels: 

    • -Septal lines on CXR: horizontal white lines, perpendicular to the pleura:

    No impairment of lung function with interstitial edema

    • Alveolar edema:
    • -Fluid in the alveolar space
    • -CXR demonstrates (usually) bilateral, symmetric opacity that is most often worse at the base of the lungs:

    "butterfly" or "bat" wing appearance
  3. Pulmonary Edema
    pathogenesis
    Starling equation: movement of fluid across a membrane

    • NET FLUID OUT = K [ (Pc-Pi) -σ(πc-πi)]
    • -hydrostatic pressures
    • -osmotic pressures

    -Continuous loss of fluid out of the capillaries into the interstitial space, eventually leaves via the lymphatics. 

    • Pathogenesis:
    • 1. Increase in capillary hydrostatic pressure [Pc]
    • (Increase in alveolar pressure causes compensatory increase in lymph flow)
    • - myocardial infarction
    • - hypertensive left ventricular failure
    • - mitral stenosis
    • - mitral stenosis
    • - transfusion overload
    • - pulmonary veno-occlusive disease

    • 2. Increase capillary permeability [K, σ, πi]
    • - inhaled or circulating toxins 
    • - adult respiratory distress syndrome
    • - radiation
    • - oxygen toxicity
    • edema fluid has high protein concentration
    • 3. Decrease in interstitial hydrostatic pressure [Pi]
    • (common cause of unilateral pulmonary edema)
    • - rapid removal of pleural effusion or   pneumothorax
    • - rapid re-expansion of collapsed lung
    • - hyperinflation of lung

    • 4. Decrease colloid osmotic pressure [πc]
    • - Saline oversaturation
    • - Hypoproteinemia

    • 5. Lymphoid insufficiency
    • - silicosis (rare - from sand blasting)
    • - lymphangitis carcinomatosa
    • - lung transplantation (loss of lymphatics)

    • 6. Uncertain etiology
    • high-altitude pulmonary edema (HAPE)
    • 1. Strong association with high pulmonary artery pressure but normal wedge pressures
    • 2. High permeability edema with high concentrations of large molecular weight proteins, cell
    • (high protein concentration on lavage; thought to be due to uneven hypoxemic vasoconstriction, leading to high pressure in some capillaries --> rupture)

    • - heroin, morphine
    • - pneurogenic pulmonary edema
  4. Pulmonary Edema
    Clinical presentation
    • dyspnea, orthopnea, paroxysmal nocturnal dyspnea -- sx thought to be from stimulation of J (juxtacapillary) receptors on the vagus nerve
    • cough, may be pink frothy sputum
    • crepitations on auscultation
    • radiograph: septal lines, blotchy shadowing
  5. Pulmonary Edema
    Lung function
    • Interstitial edema:
    • - Generally has little effect
    • - Some evidence that lung compliance is reduced
    • - Perivascular and peribronchial cuffing may increase pulmonary vascular and airway resistance

    Alveolar edema:

    • 1. Mechanics
    • - Lung compliance is reduced
    • - Airway resistance is increased

    • 2. Gas exchange
    • - Hypoxemia due to shunt and ventilation-perfusion inequality
    • - No CO2 retention

    3. Pulmonary vascular resistance increased

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