Diagnosi

s
Slide 41
Pulmonar
y Edema

Etiology

Pathophysiology

Pulmonary edema is the

excessive leakage of
interstitial fluids which
accumulates in alveolar
spaces. It reults from
hemodynamic distrurbances
or from direct increases in
capillary permeability, as a
result of microvascular injury.

a. Hemodynamic
Pulmonary edema
-fluid accumulates
initially in the basal
region of the lower
lobes because
hydrostatic pressure is
the greatest in these
sites (dependent
edema).

a.Hemodynamic Pulmonary
edema
-due to increased hydrostatic
pressure
-occurs most commonly in
Left-sided congestive heart
failure.
b.Edema caused by
microvascular (alveolar)
injury.
-also known as
noncardiogenic pulmonary
edema
-due to injury in the alveolar
septa

b. Edema caused by
microvascular
(alveolar) injury
-it is due to an injury
in the alveolar septa.
-primary injury to the
vascular endothelium
or damage to alveolar
epithelial cells
produces and
inflammatory exudate
that leaks into the
interstitial space, and
in more severe cases,
into the alveoli. In
most forms of
pneumonia, the
edema remains
localized and is
overshadowed by the
manifestations of
infection.
-when diffuse, it
contributes to ARDS.

Gross and Histologic

Features
Gross: Engorged, Soggy,
Wet lungs
Histologically, the alveolar
capillaries are engorged,
and an intra-alveolar
transudate appears as
finely granular pale pink
material.
Alveolar
microhemorrhages and
hemosiderin-laden
macrophages (heart
failure cells) may be
present.
In long standing
pulmonary congestion (in
mitral stenosis),
hemosiderin laden
macrophages are
abundant and thickening
of the alveolar walls
cause soggy lungs to
become firm and brown
(Brown Induration).

Incidence

Clinical Manifestations

Treatment

Prog

a. Hemodynamic
Pulmonary edema
-common in
conditions such
as:
1. Left sided heart
failure
2. Volume
overload
3. Pulmonary Vein
Obstruction

Symptoms of pulmonary
edema may include:

Pulmonary edema is
almost always treated
in the emergency
room or hospital. You
may need to be in an
intensive care unit
(ICU).
Oxygen is
given through a face
mask or tiny plastic
tubes are placed in the
nose.

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b. Edema caused
by microvascular
(alveolar) injury
1.
Hypoalbuminemia
2. Nephrotic
Syndrome
3. Liver disease
4. Protein-losing
enteropathies

Coughing up
blood or bloody froth
Difficulty
breathing when lying
down (orthopnea)
Feeling of "air
hunger" or "drowning"
(This feeling is called
"paroxysmal nocturnal
dyspnea" if it causes you
to wake up and try to
catch your breath.)
Grunting,
gurgling, or wheezing
sounds with breathing
Problems
speaking in full
sentences because of
shortness of breath
Other symptoms may
include:
Anxiety or
restlessness
Leg or
abdominal swelling
Pale skin
Sweating
(excessive)

A breathing
tube may be placed
into the windpipe
(trachea) so you can
be connected to a
breathing machine
(ventilator) if you
cannot breathe well on
your own.
The cause of edema
should be identified
and treated quickly.
For example, if a heart
attack has caused the
condition, it must be
treated right away.
Medicines that may be
used include:
Diuretics that
remove excess fluid
from the body
Medicines
that strengthen the
heart muscle, control
the heartbeat, or
relieve pressure on the
heart