Acute Interstitial Pulmonary

Edema

By : Fadhel J Anugerah
11-001

Pembimbing :
dr. Yanuel Aziz Sp.Rad
Anatomy Of Thorax
Pulmonary Anatomy
Nine Abdomen Region
 Background
Pulmonary edema is fluid accumulation in the tissue and air
spaces of the lungs. It leads to impaired gas exchange and
may cause respiratory failure. It is due to either failure of the
left ventricle of the heart to remove blood adequately from
the pulmonary circulation (cardiogenic pulmonary edema), or
an injury to the lung parenchyma or vasculature of the lung
(noncardiogenic pulmonary edema). Treatment is focused on
three aspects: firstly improving respiratory function, secondly,
treating the underlying cause, and thirdly avoiding further
damage to the lung. Pulmonary edema, especially acute, can
lead to fatal respiratory distress or cardiac arrest due to
hypoxia. It is a cardinal feature of congestive heart failure.
 Definition
Acute Pulmonary Oedema (APO) refers to the rapid buildup of
fluid in the alveoli and lung interstitium that has extravasated
out of the pulmonary circulation. As the fluid Accumulates, It
impairs gas exchange and decreases lung compliance,
producing dyspnoea and hypoxia. The pathophysiological
mechanism are traditionally categorised into two primary
causes.
 Cardiogenic
Cardiogenic APO occurs when cardiac output drops despite an
increased systemic resistance, so that blood returning to the
left astrium exceeds that leaving the left ventricle (LV). As a
result, pulmonary venous pressure increases, causing the
capillary hydrostatic pressure in the lungs to exceed the
oncotic pressure of the blood, leading to a net filtration of
protein poor fluid out of the capillaries.
Examples Include
A.Left ventriculer failure (LVF):
- Acute coronary Syndromes (ACS)
- Arrhytmia
- Pericarditis, myocarditis or endo carditis
- Valve dysfunction (e.g aortic stenosis mitral regurgitation)

B.Increased Intravasculer volume:

- Fluid Overload
- Non-compliance with fluid restrictionor diuretics
- Renal failure

C.Pulmonary venous outflow obstruction

- Mitral valve stenosis
 Non Cardiogenic

Pathological processes acting either directly or indirectly on

the pulmunary vascular permeability are though to cause this
from of APO. As the result, proteins leak from the capillaries,
increasing the ininterstitial oncotic pressure, so that it exceeds
that of the blood and fluidis subsequently drawn from the
capillaries.
Example Includes
A. High output states
-Septicaemia
-Anaemia
-Thyrotoxicosis

B. Systemic increase of vascular permeability

-Pancreatitis
-Eclampsia
-Disseminated Intravascular Coagulation (DIC)
-Burns
C. Toxins / Enviromental
-Immersion / Submersion
-Toxic Inhalation
-High Attitude Pulmonary Oedema (HAPE) & decompresion illnes

D. Others
-Head Injury/ Intracranial haemorrhage
-Drugs (e.g NSAID, Calcium channnel blockers and naloxone )
-Pulmonary Embolus
 Signs and symptoms

The most common symptom of pulmonary edema is

difficulty breathing, but may include other symptoms such as
coughing up blood (classically seen as pink, frothy sputum),
excessive sweating, anxiety, and pale skin. Shortness of breath
can manifest as orthopnea (inability to lie down flat due to
breathlessness) and/or paroxysmal nocturnal dyspnea (episodes
of severe sudden breathlessness at night).
 These are common presenting symptoms of chronic pulmonary
edema due to left ventricular failure. The development of
pulmonary edema may be associated with symptoms and signs of
"fluid overload"; this is a non specific term to describe the
manifestations of left ventricular failure on the rest of the body
and includes peripheral edema (swelling of the legs, in general, of
the "pitting" variety, wherein the skin is slow to return to normal
when pressed upon), raised jugular venous pressure and
hepatomegaly, where the liver is enlarged and may be tender or
even pulsatile. Other signs include end-inspiratory crackles
(sounds heard at the end of a deep breath) on auscultation and
the presence of a third heart sound
 Conclusion
Edem paru bisa dibagi menjadi kardiogenik dan non
kardiogenik. Edema paru non kardiogenik terjadi akibat dari
transudasi cairan dari pembuluh-pembuluh kapiler paru-paru ke
dalam ruang interstisial dan alveolus paru-paru yang diakibatkan
selain kelainan pada jantung. Kelainan tersebut bisa diakibatkan
oleh peningkatan tekanan hidrostatik atau penurunan tekanan
onkotik (osmotik) antara kapiler paru dan alveoli, dan terjadinya
peningkatan permeabilitas kapiler paru yang bisa disebabkan
berbagai macam penyakit atau yang sering disebut dengan acute
respiratory distress syndrom. Sedangkan pada kardiogenik atau
edem paru hidrostatik atau edem hemodinamik karena infark
miokars, hipertensi, penyakit jantung katup, eksaserbasi gagal
jantung sistolik/ diastolik dan lainnya.
 Pada pemeriksaan foto toraks memperlihatkan adanya
infiltrat-infiltrat bilateral yang difus, kadang-kadang satu paru-
paru terserang lebih hebat dari paru-paru lainnya. Pemeriksaan
analisa gas darah dan CT Scan toraks juga dapat membantu
menegakkan diagnosis serta memberikan petunjuk dalam
pengobatan.Termasuk jika kardiogenik, perlu pemeriksaan EKG
dan Ekhokhardiografi.