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Pulmonary Edema
Melissa L. Rosado de Christenson, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Pulmonary edema: Abnormal accumulation of extravascular lung water
          • Hydrostatic edema
            • Common etiologies
              • Cardiogenic edema: Elevated pulmonary capillary pressure (left ventricular failure, mitral stenosis)
              • Fluid overload: IV fluid overadministration, renal failure
            • Other (and uncommon) etiologies
              • Acute and chronic pulmonary thromboembolism
              • Acute asthma
              • Postobstructive pulmonary edema (negative pressure pulmonary edema)
              • Acute and chronic thromboembolism
              • Pulmonary venoocclusive disease
              • Pulmonary vein occlusion: Neoplasm, fibrosing mediastinitis, ablation for atrial fibrillation
          • Permeability edema with diffuse alveolar damage (DAD)
            • Acute respiratory distress syndrome (ARDS)
            • Fat embolism syndrome
          • Permeability edema without DAD
            • Opiate overdose, IV cocaine, crack cocaine inhalation
            • Transfusion-related lung injury (TRALI): Dyspnea, hypoxemia, and bilateral pulmonary opacities within 6 hours after transfusion of blood products
            • High-altitude pulmonary edema (HAPE)
            • Immunotherapy: Cytokine administration [e.g., interleukin-2 (IL-2)]
            • Smoke inhalation
          • Mixed edema: Both hydrostatic and permeability edema
            • Neurogenic pulmonary edema
            • Reexpansion pulmonary edema
            • Reperfusion edema: Pulmonary endarterectomy, balloon pulmonary angioplasty
              • Up to 72 hours post procedure
              • ↑ risk with ↑ severity of chronic thromboembolic pulmonary hypertension
              • May follow lung transplantation
            • Drowning pulmonary edema
            • Postpneumonectomy pulmonary edema
          • Other causes of pulmonary edema with complex physiology
            • Pulmonary embolism
            • Immersion pulmonary edema
            • Tocolytic therapy to delay premature delivery, preeclampsia, eclampsia

      IMAGING

      • Radiographic Findings

        • CT Findings

          • Ultrasonographic Findings

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  • Microscopic Features

                    CLINICAL ISSUES

                    • Presentation

                      • Natural History & Prognosis

                        • Treatment

                          DIAGNOSTIC CHECKLIST

                          • Consider

                            Selected References

                            1. Barile M: Pulmonary edema: a pictorial review of imaging manifestations and current understanding of mechanisms of disease. Eur J Radiol Open. 7:100274, 2020
                            2. Tsuchiya N et al: Imaging findings of pulmonary edema: part 1. Cardiogenic pulmonary edema and acute respiratory distress syndrome. Acta Radiol. 61(2):184-94, 2020
                            3. Tsuchiya N et al: Imaging findings of pulmonary edema: part 2. Infrequent or unusual pulmonary edema with definitive imaging findings. Acta Radiol. 61(2):195-203, 2020
                            4. Dobbe L et al: Cardiogenic pulmonary edema. Am J Med Sci. 358(6):389-97, 2019
                            5. Assaad S et al: Assessment of pulmonary edema: principles and practice. J Cardiothorac Vasc Anesth. 32(2):901-14, 2018
                            6. Liu XY et al: Predicting cardiogenic pulmonary edema in heart failure patients by using an N-terminal pro-b-type natriuretic peptide (NT-pro BNP) -based score. Clin Chim Acta. 480:26-33, 2018
                            7. Martindale JL et al: Diagnosing acute heart failure in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 23(3):223-42, 2016
                            8. Bentz MR et al: Intensive care unit imaging. Clin Chest Med. 36(2):219-34, 2015
                            9. Vlaar AP et al: Transfusion-related acute lung injury: a clinical review. Lancet. 382(9896):984-94, 2013
                            10. Sakellaridis T et al: Re-expansion pulmonary edema in a patient with total pneumothorax: a hazardous outcome. Gen Thorac Cardiovasc Surg. 60(9):614-7, 2012
                            11. Chatterjee K. The Swan-Ganz catheters: past et al: a viewpoint. Circulation. 2009 Jan 6;119(1):147-52. Erratum in: Circulation. 119(21):e548, 2009
                            12. Evans DC et al: Complications associated with pulmonary artery catheters: a comprehensive clinical review. Scand J Surg. 98(4):199-208, 2009
                            13. Wang CS et al: Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 294(15):1944-56, 2005
                            14. Ware LB et al: Clinical practice. acute pulmonary edema. N Engl J Med. 353(26):2788-96, 2005
                            15. Gehlbach BK et al: The pulmonary manifestations of left heart failure. Chest. 125(2):669-82, 2004
                            16. Gluecker T et al: Clinical and radiologic features of pulmonary edema. Radiographics. 19(6):1507-31; discussion 1532-3, 1999
                            17. Woolley K et al: Pulmonary parenchymal manifestations of mitral valve disease. Radiographics. 19(4):965-72, 1999
                            18. Ketai LH et al: A new view of pulmonary edema and acute respiratory distress syndrome. J Thorac Imaging. 13(3):147-71, 1998
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                TERMINOLOGY

                                • Definitions

                                  • Pulmonary edema: Abnormal accumulation of extravascular lung water
                                    • Hydrostatic edema
                                      • Common etiologies
                                        • Cardiogenic edema: Elevated pulmonary capillary pressure (left ventricular failure, mitral stenosis)
                                        • Fluid overload: IV fluid overadministration, renal failure
                                      • Other (and uncommon) etiologies
                                        • Acute and chronic pulmonary thromboembolism
                                        • Acute asthma
                                        • Postobstructive pulmonary edema (negative pressure pulmonary edema)
                                        • Acute and chronic thromboembolism
                                        • Pulmonary venoocclusive disease
                                        • Pulmonary vein occlusion: Neoplasm, fibrosing mediastinitis, ablation for atrial fibrillation
                                    • Permeability edema with diffuse alveolar damage (DAD)
                                      • Acute respiratory distress syndrome (ARDS)
                                      • Fat embolism syndrome
                                    • Permeability edema without DAD
                                      • Opiate overdose, IV cocaine, crack cocaine inhalation
                                      • Transfusion-related lung injury (TRALI): Dyspnea, hypoxemia, and bilateral pulmonary opacities within 6 hours after transfusion of blood products
                                      • High-altitude pulmonary edema (HAPE)
                                      • Immunotherapy: Cytokine administration [e.g., interleukin-2 (IL-2)]
                                      • Smoke inhalation
                                    • Mixed edema: Both hydrostatic and permeability edema
                                      • Neurogenic pulmonary edema
                                      • Reexpansion pulmonary edema
                                      • Reperfusion edema: Pulmonary endarterectomy, balloon pulmonary angioplasty
                                        • Up to 72 hours post procedure
                                        • ↑ risk with ↑ severity of chronic thromboembolic pulmonary hypertension
                                        • May follow lung transplantation
                                      • Drowning pulmonary edema
                                      • Postpneumonectomy pulmonary edema
                                    • Other causes of pulmonary edema with complex physiology
                                      • Pulmonary embolism
                                      • Immersion pulmonary edema
                                      • Tocolytic therapy to delay premature delivery, preeclampsia, eclampsia

                                IMAGING

                                • Radiographic Findings

                                  • CT Findings

                                    • Ultrasonographic Findings

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          PATHOLOGY

                                          • General Features

                                            • Microscopic Features

                                              CLINICAL ISSUES

                                              • Presentation

                                                • Natural History & Prognosis

                                                  • Treatment

                                                    DIAGNOSTIC CHECKLIST

                                                    • Consider

                                                      Selected References

                                                      1. Barile M: Pulmonary edema: a pictorial review of imaging manifestations and current understanding of mechanisms of disease. Eur J Radiol Open. 7:100274, 2020
                                                      2. Tsuchiya N et al: Imaging findings of pulmonary edema: part 1. Cardiogenic pulmonary edema and acute respiratory distress syndrome. Acta Radiol. 61(2):184-94, 2020
                                                      3. Tsuchiya N et al: Imaging findings of pulmonary edema: part 2. Infrequent or unusual pulmonary edema with definitive imaging findings. Acta Radiol. 61(2):195-203, 2020
                                                      4. Dobbe L et al: Cardiogenic pulmonary edema. Am J Med Sci. 358(6):389-97, 2019
                                                      5. Assaad S et al: Assessment of pulmonary edema: principles and practice. J Cardiothorac Vasc Anesth. 32(2):901-14, 2018
                                                      6. Liu XY et al: Predicting cardiogenic pulmonary edema in heart failure patients by using an N-terminal pro-b-type natriuretic peptide (NT-pro BNP) -based score. Clin Chim Acta. 480:26-33, 2018
                                                      7. Martindale JL et al: Diagnosing acute heart failure in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 23(3):223-42, 2016
                                                      8. Bentz MR et al: Intensive care unit imaging. Clin Chest Med. 36(2):219-34, 2015
                                                      9. Vlaar AP et al: Transfusion-related acute lung injury: a clinical review. Lancet. 382(9896):984-94, 2013
                                                      10. Sakellaridis T et al: Re-expansion pulmonary edema in a patient with total pneumothorax: a hazardous outcome. Gen Thorac Cardiovasc Surg. 60(9):614-7, 2012
                                                      11. Chatterjee K. The Swan-Ganz catheters: past et al: a viewpoint. Circulation. 2009 Jan 6;119(1):147-52. Erratum in: Circulation. 119(21):e548, 2009
                                                      12. Evans DC et al: Complications associated with pulmonary artery catheters: a comprehensive clinical review. Scand J Surg. 98(4):199-208, 2009
                                                      13. Wang CS et al: Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 294(15):1944-56, 2005
                                                      14. Ware LB et al: Clinical practice. acute pulmonary edema. N Engl J Med. 353(26):2788-96, 2005
                                                      15. Gehlbach BK et al: The pulmonary manifestations of left heart failure. Chest. 125(2):669-82, 2004
                                                      16. Gluecker T et al: Clinical and radiologic features of pulmonary edema. Radiographics. 19(6):1507-31; discussion 1532-3, 1999
                                                      17. Woolley K et al: Pulmonary parenchymal manifestations of mitral valve disease. Radiographics. 19(4):965-72, 1999
                                                      18. Ketai LH et al: A new view of pulmonary edema and acute respiratory distress syndrome. J Thorac Imaging. 13(3):147-71, 1998