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excessive crowding; "traffic congestion" (同)over-crowding
excessive accumulation of blood or other fluid in a body part

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(人・貨物などの)密集,充満;混雑,雑踏・うっ血,充血
肺の;肺を冒す

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/02 16:10:24」(JST)

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Pulmonary edema (American English), or oedema (British English; both words from the Greek οἴδημα), is fluid accumulation in the air spaces and parenchyma of the lungs.^[1] 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 adequately remove blood from the pulmonary circulation ("cardiogenic pulmonary edema"), or an injury to the lung parenchyma or vasculature of the lung ("noncardiogenic pulmonary edema").^[2] 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 in the acute setting, can lead to respiratory distress, cardiac arrest due to hypoxia, and death.

Symptoms and signs

The overwhelming symptom of pulmonary edema is difficulty breathing, but may also include 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 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.^[2]

Causes

Pulmonary edema on CT-scan (coronal MPR)

Pulmonary edema is an accumulation of fluid within the parenchyma and air spaces of the lungs. Classically it is cardiogenic (left ventricular) but fluid may also accumulate due to damage to the lung. This damage may be direct injury or injury mediated by high pressures within the pulmonary circulation. When directly or indirectly caused by increased left ventricular pressure pulmonary edema may form when mean pulmonary pressure rises from the normal of 15 mmHg^[3] to above 25 mmHg.^[4] Broadly, the causes of pulmonary edema can be divided into cardiogenic and non-cardiogenic. By convention cardiogenic refers to left ventricular causes.

Cardiogenic

Left ventricular failure may be due to a heart attack leading to arrhythmias (tachycardia/fast heartbeat or bradycardia/slow heartbeat) and fluid overload, e.g., from kidney failure or intravenous therapy which may cause dilatation and failure of the left ventricle or may cause pulmonary edema in the absence of heart failure.

Non-cardiogenic

Hypertensive crisis. The cause of pulmonary edema in the presence of a hypertensive crisis is probably due to a combination of increased pressures in the right ventricle and pulmonary circulation and also increased systemic vascular resistance and left ventricle contractility increasing the hydrostatic pressure within the pulmonary capillaries leading to extravasation of fluid and edema.
Upper airway obstruction (negative pressure pulmonary edema^[5] )
Neurogenic causes^[6] (seizures, head trauma, strangulation, electrocution).

Other/unknown

Injury to the lung may also cause pulmonary oedema through injury to the vasculature and parenchyma of the lung. The acute lung injury-acute respiratory distress syndrome (ALI-ARDS) covers many of these causes, but they may include:

Inhalation of hot or toxic gases
Pulmonary contusion, i.e., high-energy trauma (e.g. vehicle accidents)
Aspiration, e.g., gastric fluid
Reexpansion, i.e. post large volume thoracocentesis, resolution of pneumothorax, post decortication, removal of endobronchial obstruction, effectively a form of negative pressure pulmonary oedema.
Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation
Immersion pulmonary edema^[7]^[8]
Multiple blood transfusions
Severe infection or inflammation which may be local or systemic. This is the classical form of ALI-ARDS.

There are also a range of causes of pulmonary edema which are less well characterised and arguably represent specific instances of the broader classifications above.

Arteriovenous malformation
Hantavirus pulmonary syndrome
High altitude pulmonary edema (HAPE), probably a manifestation of neurogenic pulmonary edema^[9]^[10]
Envenomation, such as with the venom of Atrax robustus^[11]
Flash pulmonary edema
Swimming induced pulmonary edema

Diagnosis

X-Ray showing Pulmonary oedema

There is no one single test for confirming that breathlessness is caused by pulmonary edema; indeed, in many cases, the cause of shortness of breath is probably multifactorial.

Low oxygen saturation and disturbed arterial blood gas readings support the proposed diagnosis by suggesting a pulmonary shunt. Chest X-ray will show fluid in the alveolar walls, Kerley B lines, increased vascular shadowing in a classical batwing peri-hilum pattern, upper lobe diversion (increased blood flow to the superior parts of the lung), and possibly pleural effusions. In contrast, patchy alveolar infiltrates are more typically associated with noncardiogenic edema^[2]

Especially in the case of cardiogenic pulmonary edema, urgent echocardiography may strengthen the diagnosis by demonstrating impaired left ventricular function, high central venous pressures and high pulmonary artery pressures.

Blood tests are performed for electrolytes (sodium, potassium) and markers of renal function (creatinine, urea). Liver enzymes, inflammatory markers (usually C-reactive protein) and a complete blood count as well as coagulation studies (PT, aPTT) are also typically requested. B-type natriuretic peptide (BNP) is available in many hospitals, sometimes even as a point-of-care test. Low levels of BNP (<100 pg/ml) suggest a cardiac cause is unlikely.^[2]

Prevention

In those with underlying heart disease, effective control of congestive symptoms prevents pulmonary edema.^{[citation needed]}

Dexamethasone is in widespread use for the prevention of high altitude pulmonary edema. Sildenafil is used as a preventive treatment for altitude-induced pulmonary edema and pulmonary hypertension,^[12]^[13] the mechanism of action is via phosphodiesterase inhibition which raises cGMP, resulting in pulmonary arterial vasodilation and inhibition of smooth muscle cell proliferation.^[14] While this effect has only recently been discovered, sildenafil is already becoming an accepted treatment for this condition, in particular in situations where the standard treatment of rapid descent has been delayed for some reason.^[15]

Management

The initial management of pulmonary edema, irrespective of the type or cause, is supporting vital functions. Therefore, if the level of consciousness is decreased it may be required to proceed to tracheal intubation and mechanical ventilation to prevent airway compromise. Hypoxia (abnormally low oxygen levels) may require supplementary oxygen, but if this is insufficient then again mechanical ventilation may be required to prevent complications.^{[citation needed]} Treatment of the underlying cause is the next priority; pulmonary edema secondary to infection, for instance, would require the administration of appropriate antibiotics.^{[citation needed]}

Cardiogenic pulmonary edema

Acute cardiogenic pulmonary edema often responds rapidly to medical treatment.^[16] Positioning upright may relieve symptoms. Loop diuretics such as furosemide or bumetanide are administered, often together with morphine or diamorphine to reduce respiratory distress.^[16] Both diuretics and morphine may have vasodilator effects, but specific vasodilators may be used (particularly intravenous glyceryl trinitrate or ISDN) provided the blood pressure is adequate.^[16]

Continuous positive airway pressure and bilevel positive airway pressure (BIPAP/NIPPV) has been demonstrated to reduce the need of mechanical ventilation in people with severe cardiogenic pulmonary edema, and may reduce mortality.^[17]

It is possible for cardiogenic pulmonary edema to occur together with cardiogenic shock, in which the cardiac output is insufficient to sustain an adequate blood pressure. This can be treated with inotropic agents or by intra-aortic balloon pump, but this is regarded as temporary treatment while the underlying cause is addressed.^[16]

References

^ "pulmonary edema" at Dorland's Medical Dictionary
^ ^a ^b ^c ^d Ware LB, Matthay MA (December 2005). "Clinical practice. Acute pulmonary edema". N. Engl. J. Med. 353 (26): 2788–96. doi:10.1056/NEJMcp052699. PMID 16382065.
^ What Is Pulmonary Hypertension? From Diseases and Conditions Index (DCI). National Heart, Lung, and Blood Institute. Last updated September 2008. Retrieved on 6 April 2009.
^ Chapter 41, page 210 in: Cardiology secrets By Olivia Vynn Adair Edition: 2, illustrated Published by Elsevier Health Sciences, 2001 ISBN 1-56053-420-6, ISBN 978-1-56053-420-4
^ Papaioannou, V.; Terzi, I.; Dragoumanis, C.; Pneumatikos, I. (2009). "Negative-pressure acute tracheobronchial hemorrhage and pulmonary edema". Journal of Anesthesia 23 (3): 417–420. doi:10.1007/s00540-009-0757-0.
^ O'Leary, R.; McKinlay, J. (2011). "Neurogenic pulmonary oedema". Continuing Education in Anaesthesia, Critical Care & Pain 11 (3): 87–92. doi:10.1093/bjaceaccp/mkr006.
^ Hampson NB, Dunford RG (1997). "Pulmonary edema of scuba divers". Undersea Hyperb Med 24 (1): 29–33. PMID 9068153. Retrieved 2008-09-04.
^ Cochard G, Arvieux J, Lacour JM, Madouas G, Mongredien H, Arvieux CC (2005). "Pulmonary edema in scuba divers: recurrence and fatal outcome". Undersea Hyperb Med 32 (1): 39–44. PMID 15796313. Retrieved 2008-09-04.
^ Luks AM (2008). "Do we have a "best practice" for treating high altitude pulmonary edema?". High Alt. Med. Biol. 9 (2): 111–4. doi:10.1089/ham.2008.1017. PMID 18578641.
^ Bates, M (2007). "High altitude pulmonary edema". Altitude Physiology Expeditions. Retrieved 2008-09-04.
^ White J, Gray M, Fisher M (1989). Atrax Robustus IPCS InChem
^ Richalet JP, Gratadour P, Robach P, et al. (2005). "Sildenafil inhibits altitude-induced hypoxemia and pulmonary hypertension". Am. J. Respir. Crit. Care Med. 171 (3): 275–81. doi:10.1164/rccm.200406-804OC. PMID 15516532.
^ Perimenis P (2005). "Sildenafil for the treatment of altitude-induced hypoxaemia". Expert Opin Pharmacother 6 (5): 835–7. doi:10.1517/14656566.6.5.835. PMID 15934909.
^ Clark, Michael; Kumar, Parveen J. (2009). Kumar and Clark's clinical medicine. St. Louis, Mo: Elsevier Saunders. p. 783. ISBN 0-7020-2993-9.
^ Fagenholz PJ, Gutman JA, Murray AF, Harris NS (2007). "Treatment of high altitude pulmonary edema at 4240 m in Nepal". High Alt. Med. Biol. 8 (2): 139–46. doi:10.1089/ham.2007.3055. PMID 17584008.
^ ^a ^b ^c ^d Cleland JG, Yassin AS, Khadjooi K (2010). "Acute heart failure: focusing on acute cardiogenic pulmonary oedema". Clin Med 10 (1): 59–64. doi:10.7861/clinmedicine.10-1-59. PMID 20408310.
^ Vital FM, Ladeira MT, Atallah AN (2013). "Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema". Cochrane Database Syst Rev 5: CD005351. doi:10.1002/14651858.CD005351.pub3. PMID 23728654.

External links

HeartFailureMatters.org Animation showing How Heart Failure causes Fluid Accumulation - Created by the European Heart Failure Association

UpToDate Contents

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1. 急性非代償性心不全の評価 evaluation of acute decompensated heart failure
2. 非心原性肺水腫 noncardiogenic pulmonary edema
3. 心原性肺水腫の病態生理 pathophysiology of cardiogenic pulmonary edema
4. 成人における肺高血圧症の概要 overview of pulmonary hypertension in adults
5. 総肺静脈還流異常症 total anomalous pulmonary venous connection

English Journal

Effects of the mTOR inhibitor everolimus and the PI3K/mTOR inhibitor NVP-BEZ235 in murine acute lung injury models.

Üstün S1, Lassnig C2, Preitschopf A1, Mikula M1, Müller M2, Hengstschläger M1, Weichhart T3.
Transplant immunology.Transpl Immunol.2015 Sep;33(1):45-50. doi: 10.1016/j.trim.2015.06.001. Epub 2015 Jun 11.
The mammalian target of rapamycin (mTOR) is a key signaling kinase associated with a variety of cellular functions including the regulation of immunological and inflammatory responses. Classic mTOR inhibitors such as rapamycin or everolimus are commonly used in transplant as well as cancer patients
PMID 26073719

Phenotypic features and phylogenetic background of extraintestinal hemolytic Escherichia coli responsible of mortality in puppies.

Turchetto S1, Ustulin M2, Citterio CV3, Zanardello C4, Vascellari M5, Vio D6, Conedera G7, Milone NM8, Cocchi M9.
Veterinary microbiology.Vet Microbiol.2015 Aug 31;179(1-2):126-30. doi: 10.1016/j.vetmic.2015.03.004. Epub 2015 Mar 14.
A 10-day-old litter of five puppies of Bracco Italiano dog breed showed weakness and diarrhea and, 2 days later, four of them died. At the same time, the bitch showed high hyperthermia (40°C) and endometritis. The necropsy of a puppy revealed a severe lobar pneumonia accompanied with a bilateral ne
PMID 25835470

Magnolin inhibits cell migration and invasion by targeting the ERKs/RSK2 signaling pathway.

Lee CJ1, Lee MH2, Yoo SM3, Choi KI4, Song JH5, Jang JH6,7, Oh SR8, Ryu HW9, Lee HS10, Surh YJ11, Cho YY12.
BMC cancer.BMC Cancer.2015 Aug 8;15:576. doi: 10.1186/s12885-015-1580-7.
BACKGROUND: Magnolin is a natural compound abundantly found in Magnolia flos, which has been traditionally used in oriental medicine to treat headaches, nasal congestion and anti-inflammatory reactions. Our recent results have demonstrated that magnolin targets the active pockets of ERK1 and ERK2, w
PMID 26253302

Japanese Journal

Diffuse Alveolar Hemorrhage with Predominantly Right-sided Infiltration Resulting from Cardiac Comorbidities

, , , ,
Internal Medicine 54(3), 319-324, 2015
… The leading etiology was pulmonary congestion due to heart failure (n=15). … Predominantly right-sided DAH was often caused by pulmonary congestion resulting from heart failure (10 of 18 patients). … Conclusion Predominantly right-sided DAH is frequently caused by pulmonary congestion resulting from heart failure and is significantly related to comorbidities with cardiovascular disease. …
NAID 130004903033

先天性門脈体循環シャントに対するシャント血管結紮術5例の経験

高間勇一,上野豪久,井深奏司,上原秀一郎,曺英樹,臼井規朗,福澤正洋,奥山宏臣
日本小児外科学会雑誌 51(1), 51-57, 2015
【目的】先天性門脈体循環シャントは，門脈血が直接体循環へ流入することで高アンモニア血症，肝肺症候群，肝性脳症などを来す疾患である．無症候性の場合もあるが有症状例にはシャント血流遮断が必要となる．当院で施行した先天性門脈体循環シャントに対する外科治療をまとめ，安全性と有用性について検討する．【方法】2000 年1 月から2012 年12 月に外科治療を施行した5 例を対象とした．術前状態，術中門脈圧 …
NAID 130004897775

産科大出血に対する大量輸血後の肺うっ血を契機に診断された僧帽弁逸脱症の1例

丹保亜希仁,川田大輔,西浦猛,稲垣泰好,鈴木昭広,小北直宏,赤坂伸之,藤田智
日本集中治療医学会雑誌 22(2), 145-146, 2015
NAID 130004846930

Related Pictures

★リンクテーブル★

リンク元	「肺うっ血」「うっ血肺」
関連記事	「congestion」「pulmonary」

「肺うっ血」

Pulmonary edema
	Classification and external resources
	Pulmonary edema with small pleural effusions on both sides.
ICD-10	J81
ICD-9	514 518.4
DiseasesDB	11017
MedlinePlus	000140
eMedicine	article/157452 article/300813, article/360932
MeSH	D011654

　　[★]

英: pulmonary congestion, lung congestion
関: うっ血肺

肺血管内血液量の増加。肺血管外水分量は増加しない(SPU.146)　　　⇔　　肺水腫：肺血管外へ異常な水分貯留がある病的状態

出典不明↓この解説は間違いの可能性がある

肺うっ血	血漿成分が間質に漏出	periarterial edema, カーリーBライン、血管陰影増強(シャントがあるときには認められない？)
肺水腫	血漿成分が肺胞腔に漏出

「うっ血肺」

　　[★]

英: congested lung
同: 肺うっ血 pulmonary congestion
関: 心性肺

「congestion」

　　[★]

n.

1.密集、充満、混雑、過密
2.(医)鬱血、詰まること
3.(通信回線の)混雑状態
4.輻輳、輻湊

「pulmonary」

　　[★]

adj.

肺の、肺性の

関: lung、pneumo

[1] "pulmonary edema" at Dorland's Medical Dictionary

[Ware-2] Ware LB, Matthay MA (December 2005). "Clinical practice. Acute pulmonary edema". N. Engl. J. Med. 353 (26): 2788–96. doi:10.1056/NEJMcp052699. PMID 16382065.

[3] What Is Pulmonary Hypertension? From Diseases and Conditions Index (DCI). National Heart, Lung, and Blood Institute. Last updated September 2008. Retrieved on 6 April 2009.

[4] Chapter 41, page 210 in: Cardiology secrets By Olivia Vynn Adair Edition: 2, illustrated Published by Elsevier Health Sciences, 2001 ISBN 1-56053-420-6, ISBN 978-1-56053-420-4

[5] Papaioannou, V.; Terzi, I.; Dragoumanis, C.; Pneumatikos, I. (2009). "Negative-pressure acute tracheobronchial hemorrhage and pulmonary edema". Journal of Anesthesia 23 (3): 417–420. doi:10.1007/s00540-009-0757-0.

[6] O'Leary, R.; McKinlay, J. (2011). "Neurogenic pulmonary oedema". Continuing Education in Anaesthesia, Critical Care & Pain 11 (3): 87–92. doi:10.1093/bjaceaccp/mkr006.

[pmid9068153-7] Hampson NB, Dunford RG (1997). "Pulmonary edema of scuba divers". Undersea Hyperb Med 24 (1): 29–33. PMID 9068153. Retrieved 2008-09-04.

[pmid15796313-8] Cochard G, Arvieux J, Lacour JM, Madouas G, Mongredien H, Arvieux CC (2005). "Pulmonary edema in scuba divers: recurrence and fatal outcome". Undersea Hyperb Med 32 (1): 39–44. PMID 15796313. Retrieved 2008-09-04.

[pmid18578641-9] Luks AM (2008). "Do we have a "best practice" for treating high altitude pulmonary edema?". High Alt. Med. Biol. 9 (2): 111–4. doi:10.1089/ham.2008.1017. PMID 18578641.

[10] Bates, M (2007). "High altitude pulmonary edema". Altitude Physiology Expeditions. Retrieved 2008-09-04.

[11] White J, Gray M, Fisher M (1989). Atrax Robustus IPCS InChem

[12] Richalet JP, Gratadour P, Robach P, et al. (2005). "Sildenafil inhibits altitude-induced hypoxemia and pulmonary hypertension". Am. J. Respir. Crit. Care Med. 171 (3): 275–81. doi:10.1164/rccm.200406-804OC. PMID 15516532.

[13] Perimenis P (2005). "Sildenafil for the treatment of altitude-induced hypoxaemia". Expert Opin Pharmacother 6 (5): 835–7. doi:10.1517/14656566.6.5.835. PMID 15934909.

[14] Clark, Michael; Kumar, Parveen J. (2009). Kumar and Clark's clinical medicine. St. Louis, Mo: Elsevier Saunders. p. 783. ISBN 0-7020-2993-9.

[15] Fagenholz PJ, Gutman JA, Murray AF, Harris NS (2007). "Treatment of high altitude pulmonary edema at 4240 m in Nepal". High Alt. Med. Biol. 8 (2): 139–46. doi:10.1089/ham.2007.3055. PMID 17584008.

[Cleland-16] Cleland JG, Yassin AS, Khadjooi K (2010). "Acute heart failure: focusing on acute cardiogenic pulmonary oedema". Clin Med 10 (1): 59–64. doi:10.7861/clinmedicine.10-1-59. PMID 20408310.

[CochraneCPAP-17] Vital FM, Ladeira MT, Atallah AN (2013). "Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema". Cochrane Database Syst Rev 5: CD005351. doi:10.1002/14651858.CD005351.pub3. PMID 23728654.

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案内

案内

pulmonary congestion