Pulmonary Edema

Pulmonary Edema

The Common vein

Copyright 2009

Definition

Pulmonary edema is a circulatory abnormality of the pulmonary circulation with multiple causes, but most commonly due to left ventricular failure and resulting in the  accumulation of fluid in the interstitium and alveoli of the lungs .

Clinically it results in shortness of breath, coughing, coughing up blood, breathing difficulty, wheezing, sweating, skin paleness, nasal flaring, and behavioral problems.

It is diagnosed clinically by observation, listening to respiratory sounds, oxygen level measurement, chest x-ray, and ultrasound.

Treatment includes the administration of  oxygen, diuretic and cardiac support and if severe may require  intubation, and ventilatory support.

Cardiogenic Shock 

ALVEOLAR EDEMA – CARDIOGENIC PULMONARY EDEMA 
TAKOTSUBO CARDIOMYOPATHY
74-year-old male with type 2 diabetes, CAD s/p stent 6 years prior, hypertension and hypercholesterolemia, e presenting in shock. (NYHA Class IV and ASA Class 4)
CXR showed pulmonary edema.
EKG showed new LBB
Echo at the bedside in the ICU showed an ejection fraction of 15%, with global hypokinesis sparing the base of the heart. There was moderate MR, PAP 44-65mm Hg, RV was normal.
Preliminary diagnosis of an acute MI was made with acute systolic heart failure and cardiogenic shock.
He was transferred to the cath lab for evaluation.
Prior to gaining access to the arterial system the patient went into PEA requiring sustained CPR requiring both epinephrine, atropine and urgent intubation
Emergent cardiac catheterization showed an LV pressure of 64/17 and wedge pressure of 41 mmHg. Temporary pacemaker was placed as well as an IABP. No significant CAD was identified. LV gram showed ballooning of the apex of the heart consistent with Takotsubo cardiomyopathy with an estimated ejection fraction of 10%
Serial CXR showed ongoing perihilar infiltrates with air bronchograms consistent with cardiogenic and alveolar edema. He passed away 2 days later
Ashley Davidoff MD

Dilated Cardiomyopathy Chronic renal Failure

34-year-old male has a normal appearing CXR 1 year before presentation
At the time of his first presentation with dyspnea his CXR showed perihilar infiltrates.
A CT confirmed progressive alveolar edema, with bilateral effusions (right greater than left), mild left ventricular dilatation, Kerley B lines and centrilobular densities and small pericardial effusion.
1 month after this admission a treadmill stress and rest gated SPECT study showed no evidence of ischemia with a calculated ejection fraction of 31%
MRI confirmed the presence of a dilated cardiomyopathy, small pericardial effusion, without evidence of LGE, global hypokinesis and EF of about 20%

DILATED CARDIOMYOPATHY, DIABETES, CRF, PANCREATITIS

Ashley Davidoff MD

DILATED CARDIOMYOPATHY, DIABETES, CRF, PANCREATITIS
Ashley Davidoff MD
DILATED CARDIOMYOPATHY, DIABETES, CRF, PANCREATITIS

Ashley Davidoff MD

KERLEY B LINES AND PROMINENT INTERLOBULAR SEPTA
DILATED CARDIOMYOPATHY, DIABETES, CRF, PANCREATITIS
Ashley Davidoff MD

 

Pulmonary Edema, Thickened Interlobular Septa and Crazy Paving 

CHF – Alveolar Edema
CT scan shows Diffuse ground glass pattern with thickening of the interlobular septa and manifesting as crazy paving pattern
Ashley Davidoff MD
References and Links