• Tuberculosis and Respiratory Diseases
• /
• v.74 no.1
• /
• pp.15-22
• /
• 2013

Background: Differentiating cardiogenic pulmonary edema from other bilateral lung diseases such as pneumonia is frequently difficult. We conducted a retrospective study to identify predictors for cardiogenic pulmonary edema and non-cardiogenic causes of bilateral lung infiltrates in chest radiographs. Methods: The study included patients who had newly developed bilateral lung infiltrates in chest radiographs and patients who underwent echocardiography. Cases were divided into two groups based on the echocardiographic findings: the cardiogenic pulmonary edema group and the non-cardiogenic group. Clinical characteristics and basic laboratory findings were analyzed to identify predictors for differential diagnosis between cardiogenic and non-cardiogenic causes of bilateral chest infiltrates. Results: We analyzed 110 subjects. Predictors of cardiogenic pulmonary edema were higher brain natriuretic peptide (BNP) levels, lower C-reactive protein (CRP) levels on the day of the event (<7 mg/dL), age over 60 years, history of heart disease, and absence of fever and sputum. CRP on the day of the event was an independent factor to differentiate cardiogenic and non-cardiogenic causes of newly developed bilateral chest infiltrates. Also, the validity was comparable to BNP. Conclusion: Clinical symptoms (sputum and fever), medical history (dyslipidemia and heart disease), and laboratory findings (BNP and CRP) could be helpful in the differential diagnosis of patients with acute bilateral lung infiltrates in chest radiographs.

• Korean Journal of Veterinary Research
• /
• v.62 no.3
• /
• pp.22.1-22.4
• /
• 2022

This study reports the efficacy of the vasodilator sodium nitroprusside (SNP), for treatment of acute cardiogenic pulmonary edema in dogs. For this study, the patients were divided into the SNP only treatment group, the SNP, furosemide and dobutamine treatment group, and non-SNP treatment group. Seven dogs, 6 dogs and 2 dogs were favorable responders in SNP only group, group with SNP, furosemide and dobutamine and non-SNP treatment group, each. The results of this study suggest that SNP can be an effective alternative therapy for dogs with acute cardiogenic pulmonary edema.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.4 no.2
• /
• pp.175-179
• /
• 2006

Welders are exposed to a number of hazards including metal fumes, toxic gases, electricity, heat, noise, and radiation such as ultraviolet and infrared light. We encountered a patient who developed non-cardiogenic pulmonary edema within a day after cutting copper pipe with an oxyethylene torch. The patient was a 26-year-old welder. He complained of dyspnea, generalized myalgia, and febrile sensation the following morning. The patient's chest X-ray and chest CT scan showed extensively distributed and ill-defined centrilobular nodules. Both his symptoms and chest X-ray abnormalities improved spontaneously. We attributed the patient's symptoms to non-cardiogenic pulmonary edema due to nitrogen dioxide, reasoning that: 1) the pipe consisted only of copper, according to material safety data sheet (MSDS); 2) a previous report in the literature demonstrated increased nitrogen dioxide levels under similar conditions; 3) the patient's clinical course and radiologic findings were very reminiscent of non-cardiogenic pulmonary edema following accidental exposure to nitrogen dioxide.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.8 no.2
• /
• pp.113-121
• /
• 2010

Purpose: Drug-induced non-cardiogenic pulmonary edema has been reported on in a drug case series. For most of the agents that cause pulmonary edema, the pathogenic mechanisms that are responsible for the pulmonary edema remain unknown. We report here on the cases of suspected drug-induced pulmonary edema and we analyze the clinical characteristics. Methods: We reviewed the medical records of 1,345 patients who had drug adverse effects and drug poisoning from January 2005 to July 2010, and 480 of these patients were admitted to the EM Department. Among them, 17 patients developed abnormal chest radiological findings and they were analyzed for any clinical characteristics, the initial symptoms, securing the airway and the clinical results. Results: Seventeen patients out of 480 (3.54%) developed drug-induced abnormal chest radiographic pulmonary edema; they displayed initial symptoms that included mental change (41.2%), dyspnea (17.6%), vomiting (11.8%), etc, and some displayed no symptoms at all (11.8%). Only 3 patients out of the 11 who died or had severe pulmonary edema were able to obtain an advanced airway prior to their arrival to the EM Department. Clinical recovery was generally rapid and this was mostly completed within 6 hours. The mortality rate was 11.8% (2 of 17 patients), and the causative drugs were found to be propofol (35.3%, 6 of 17 patients), multiple drugs (41.2% or 7 out of 17) and one patient each with ephedrine, ethylene glycol, doxylamine and an unknown drug, respectively. Conclusion: Drug-induced pulmonary edema and deaths are not uncommon, and recovery is typically rapid with few long-term sequelae when drug administration is discontinued. Oxygen therapy and securing the airway must be performed during transportation for patients with pulmonary edema.

• Tuberculosis and Respiratory Diseases
• /
• v.64 no.3
• /
• pp.219-223
• /
• 2008

Pheochromocytoma is derived from the chromaffin tissue. The typical finding of pheochromocytoma is paroxysmal hypertension accompanied with various signs and symptoms that are due to the excess of catecholamines or other bioactive substances. Yet the diagnosis is sometimes difficult to make because its clinical presentation is quite variable. Especially, hemoptysis is a very rare symptom, so the diagnosis is often missed or delayed. Without making the correct diagnosis and then subsequently administering treatment, the condition may be fatal. We herein report on a 68 year-old woman who was admitted because of abdominal pain and hemoptysis. The initial radiologic findings suggested pulmonary edema with alveolar hemorrhage. The urine catecholamine levels were elevated and she developed catecholamine-induced cardiomyopathy. We performed bronchial arterial embolization and we administered alpha blocker medication for controlling the hemoptysis and hypertension. After the temporary symptomatic improvement, her clinical course was aggravated by pneumonia and pulmonary edema. In spite of performing definitive surgery for pheochromocytoma, she died of postoperative hemodynamic instability.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.28 no.2
• /
• pp.178-182
• /
• 2006

Pulmonary edema is a well known phenomenon in medicine, physical findings indicative of this condition include frothy pink sputum, dispnea, and chest X-ray may present cephalization of vessels, perihilar edema, or diffused increase of density. It is one of the most serious, life threatening situation and should be diagnosed and managed instantly. Early diagnosis and intensive treatment are mandatory in order to effectively resolve the situation. The most common etiology for this pathology is cardiogenic, such as left ventricular failure and valvular disease. The one following is noncardiogenic, such as transfusion, infectious pneumonia, inhaled toxins, shock lung in association with trauma. Other forms of pulmonary edema which have not been clearly explained result from pulmonary embolism, drug overdose, after anesthesia, epinephrine overdose, exposure to high altitude, neurogenic, etc. We experienced two cases of pulmonary edema during two jaw surgeries(Le Fort I Osteotomy & BSSRO). These patients were young and physically healthy individuals on preoperative evaluation. Thus we report and discuss the etiology, diagnosis, prognosis, and treatment with journals review.

• Journal of the korean veterinary medical association
• /
• v.53 no.3
• /
• pp.192-197
• /
• 2017

폐부종은 심인성, 혹은 비심인성 요인에 의해 발생한다. 심인성폐부종(Cardiogenic Pulmonary Edema, CPE)은 심질환, 좌심방 압력의 증가, 폐정맥과 폐모세혈관의 압력 증가와 관련있다. 이와는 대조적으로 비심인성 폐부종(Noncardiogenic Pulmonary Edema, NCPE)은 좌심방의 압력증가에 의해서 혹은 기저질환인 심장 질환과 관련없이 발생한 국소적인 정수압의 증가하여 발생하거나, 폐포나 모세혈관내 피표면의 투과도의 변화에 의해서 발생한다. 혹은 국소적인 정수압 및 투과도의 복합적인 변화 모두에 의하여 발생한다. NCPE의 환축을 적절하게 치료하기 위하여 CPE와 반드시 감별되어야 한다. 또한, 심인성 및 NCPE의 감별 및 적절한 처치를 위하여는 철저한 환축의 병력, 신체검사, 흉부방사선 촬영 등의 검사를 실시하여야 한다. NCPE는 원발요인과 치료반응에 따라 예후가 달라질 수 있다.

• Journal of Chest Surgery
• /
• v.54 no.5
• /
• pp.419-421
• /
• 2021

Fracture of prosthetic valve leaflets in the absence of traumatic injury is very rare. Leaflet fracture can cause acute pulmonary edema and cardiogenic shock and is potentially life-threatening, requiring emergency surgery. Thus, a leaflet fracture must be diagnosed quickly and accurately. We present the case of a 46-year-old man with CarboMedics prosthetic aortic and mitral valve replacements implanted 24 years previously. The patient presented at our emergency department with abrupt dyspnea and fever. We diagnosed severe mitral valve regurgitation with anterior leaflet fracture. The patient underwent venoarterial extracorporeal membrane oxygenation and delayed mitral valve replacement. The foreign body was removed step by step because the diagnosis was missed. Two pieces of broken leaflets were found in the left common iliac artery and left external iliac artery. The patient was treated successfully and remains asymptomatic 1 year following surgery.

• Tuberculosis and Respiratory Diseases
• /
• v.42 no.4
• /
• pp.548-554
• /
• 1995

Background: Cardiogenic pulmonary edema increases nonspecific airway responsiveness in humans and animals. Increased extravascular lung water from overt pulmonary edema to subclinical interstitial edema is a common finding in patients with chronic renal failure. Several studies carried out to assess pulmonary function disturbances in this condition have documented a reduction in forced expiratory volume that usually reverses after hemodialysis, suggesting airway edema as the underlying mechanism. This interstitial edema may also lead to nonspecific bronchial hyperresponsiveness. We hypothesized that patients with chronic renal failure may present nonspecific bronchial hyperresponsiveness due to subclinical interstitial pulmonary edema. Methods: We studied 18 chronic renal failure undergoing regular hemodialysis 3 times a week(New York Heart Association Class II) without concomittent disease. These patients were checked pulmonary function test and metacholine provocation test before hemodialysis and same procedure was repeated if responsive, after hemodialysis. Results: 1) 12 out of 18 patients before hemodialysis were reactive in metacholine provocation test(66.7%) before hemodialysis. This airway hyperresponsiveness were decreased after hemodialysis. 2) Pulmonary function was improved after hemodialysis and change in $FEV_1$ was correlated with change in weight(r=-0.62, p<0.01). 3) There was a close correlation between log $PD_{20}$ and $FEF_{25}$, which is one of the variables of the peripheral airways(r=0.58, p<0.05). Conclusion: We speculated interstitial pulmonary edema may play a significant role in bronchial hyperresponsiveness and lung function impaired in patients with chronic renal failure.

• Tuberculosis and Respiratory Diseases
• /
• v.87 no.1
• /
• pp.1-11
• /
• 2024

Acute respiratory distress syndrome (ARDS) is a common cause of severe hypoxemia defined by the acute onset of bilateral non-cardiogenic pulmonary edema. The diagnosis is made by defined consensus criteria. Supportive care, including prevention of further injury to the lungs, is the only treatment that conclusively improves outcomes. The inability to find more advanced therapies is due, in part, to the highly sensitive but relatively non-specific current syndromic consensus criteria, combining a heterogenous population of patients under the umbrella of ARDS. With few effective therapies, the morality rate remains 30% to 40%. Many subphenotypes of ARDS have been proposed to cluster patients with shared combinations of observable or measurable traits. Subphenotyping patients is a strategy to overcome heterogeneity to advance clinical research and eventually identify treatable traits. Subphenotypes of ARDS have been proposed based on radiographic patterns, protein biomarkers, transcriptomics, and/or machine-based clustering of clinical and biological variables. Some of these strategies have been reproducible across patient cohorts, but at present all have practical limitations to their implementation. Furthermore, there is no agreement on which strategy is the most appropriate. This review will discuss the current strategies for subphenotyping patients with ARDS, including the strengths and limitations, and the future directions of ARDS subphenotyping.