1. Noncardiogenic Pulmonary Edema Alan Cheng AM Report 5/12/09

2. Starling Principle Net Filtration = C x (Pcap – Pint) – (Ocap – Oint) Rate of lymphatic reabsorption

3. Permeability Problems ARDS  Bilateral infiltrates, hypoxia (P:F ratio), Wedge <= 18  Sepsis  Aspiration  Pneumonia  Trauma or burns  TRALI – within 6 hours of completion of transfusion  Relief of upper airway obstruction  Lung/bone marrow transplant  Drugs/meds/alcohol

4. Hydrostatic pressure problems often due to cardiogenic pulmonary edema...)  PCWP > 18 Volume overload – renal failure  Not hepatic failure or nephrotic syndrome

5. Oncotic pressure problems Hypoalbuminemia and nephrotic syndrome rarely cause nephrotic syndrome  Lung capillaries normally are more permeable, and therefore interstitial oncotic pressure is ~ 18, and body maintains this. Thus, drop in capillary oncotic pressure does not affect lungs, but does affect periphery.  Increased lymphatics in lungs  Nephrotic syndrome will cause pulmonary edema when combined another insult, eg increased L atrial pressures.

6. Other causes of noncardiogenic pulmonary edema: High altitude pulmonary edema Neurogenic pulmonary edema Reperfusion pulmonary edema Reexpansion pulmonary edema Opiate overdose Salicylate toxicity Pulmonary embolism Viral infections

7. www.med.yale.edu/intmed/cardio/imaging/findin gs/pulmonary_edema/index.html Imaging

8. www.med.yale.edu/intmed/cardio/imaging/findin gs/pulmonary_edema/index.html Imaging

9. Young AL, Langston CS, Schiffman RL, Shortsleeve MJ. Texas Heart Inst J, 2001;28(1):53-6. Imaging Mitral regurg Right upper lobe

10. References www.med.yale.edu/intmed/cardio/imaging/findings/pulm onary_edema/index.html Young AL, Langston CS, Schiffman RL, Shortsleeve MJ. Tex Heart Inst J. 2001;28(1):53-6. UpToDate Cecil’s Essentials of Medicine, 6 th ed, 2004