Pulmonary edema

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Rsadiographic appearance of pulmonary edema in a dog due to congestive heart failure[1]

Pulmonary edema is defined as a pathologic accumulation of fluid in the extravascular space of the lung[2].

The development of pulmonary edema is divided in cardiogenic and non-cardiogenic.

Cardiogenic pulmonary edema and noncardiogenic pulmonary edema both cause interstitial edema, which is associated with perivascular and peribronchial expansion and increased lymphatic flow. Interstitial edema may progress into alveolar edema with alveolar flooding and secondary respiratory compromise[3].

Diagnosis is usually established from thoracic radiographs but brain natriuretic peptide concentration may help distinguish between cardiogenic and noncardiogenic cases.

The differentiation between cardiogenic versus non-cardiogenic genesis is not always straightforward, but most relevant, because treatment markedly differs between the two. Of further importance is the identification of the specific underlying cause in non-cardiogenic edema, not only for therapeutic but particularly for prognostic reasons. Depending on the cause the prognosis ranges from very poor to good chance of complete recovery[4].

Treatment for noncardiogenic pulmonary edema is mainly supportive, with oxygen therapy and diuretics[5].

Cardiogenic edema arises from underlying cardiac pathology which needs to be addressed with drugs such as furosemide, digoxin and pimobendan.

References

  1. Long Beach Animal Hospital
  2. Glaus T et al (2010) Cardiogenic and non cardiogenic pulmonary edema: pathomechanisms and causes. Schweiz Arch Tierheilkd 152(7):311-317
  3. Adamantos S & Hughes D (2009) Pulmonary edema. In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. St. Louis, MO: Elsevier. pp:86-90
  4. West JB (2007) Pulmonary Pathophysiology. 7th ed. Baltimore, MD: Lippincott Williams & Wilkins
  5. Dormans TP et al (1996) Vascular effects of loop diuretics. Cardiovasc Res 32:988-997