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cardiogenic pulmonary edema vs noncardiogenic pulmonary edema

December 22, 2020 0 Comments

Cardiogenic pulmonary edema was induced by inflating the balloon of a Foley catheter surgically positioned in the mitral valve orifice causing increased left atrial pressure (increases PLA). As an additional factor, lymphatic drainage counteracts extravascular fluid accumulation. 2008; 129: 287-297. Cardiogenic pulmonary edema (CPE) is defined as pulmonary edema due to increased capillary hydrostatic pressure secondary to elevated pulmonary venous pressure. 18. Pract. There are multiple thickened septal lines seen in the periphery of the lungs. Typically, the edema starts in the perihilar area progressing to the caudo-dorsal lung parts. Kerley B Lines, Congestive Heart Failure. To differentiate from cardiogenic pulmonary edema, pulmonary capillary wedge pressure is not elevated and remains less than 18 mmHg. Parent C, King LG, Van Winkle TJ, Walker LM. Respiratory function and treatment in dogs with acute respiratory distress syndrome: 19 cases (1985-1993). 2010 (in German). Non-Cardiogenic Pulmonary Edema. Am. The mechanism for developing non-cardiogenic pulmonary edema (NCPE) in the context of opiate or opioid induced hypoxia requiring reversal with naloxone (Narcan) is suggested to not only be multifactorial, but has not been fully worked out. Among these, cardiogenic e … The clinical features of injury by chewing electrical cords in dogs and cats. 1993; 203:.1699-1701. 2003; 21: 385-393. Ultrasound. enlarged, the cause was still on a cardiogenic basis. For this same photo without the arrows, click here. centrally ;located in a bat-wing configuration with no evidence of pleural effusion, 7. 1,3 In general, non-cardiogenic pulmonary edema is an acute presentation as a consequence of some coexisting clinical condition, either systemic or pulmonary. Just click, Cardiogenic and Non-Cardiogenic Pulmonary Edema--Pathomechanisms and Causes*, World Small Animal Veterinary Association World Congress Proceedings, 2010, Johann Lang, Prof.Dr.med.vet., DECVDI; Tony M. Glaus, PD, Dr.med.vet., DACVIM, DECVIM-CA, VINcyclopedia of Diseases (Formerly Associate), Books & VINcyclopedia of Diseases (Formerly Associate), Kardiales und Nicht-Kardiales Lungenödem--Pathomechanismen und Ursachen*, Johann Lang, Prof., Dr. med. Assoc. For non-cardiogenic pulmonary edema, the predisposing condition should be treated. Congestive heart failure is the leading diagnosis in hospitalized patients older than 65, Fluid first accumulates in and around the capillaries in the interlobular septa (typically at a wedge pressure of about 15 mm Hg), Further accumulation occurs in the interstitial tissues of the lungs, Finally, with increasing fluid, the alveoli fill with edema fluid (typically wedge pressure is 25 mm Hg or more). 1995; 206:1732-1736. vet., DECVDI 1. Frank AJ, Thompson BT. 20. fluid in the fissures or cardiomegaly. Rose & TW Post, McGraw-Hill, New York, 2001, 478-534. Bern, Schweiz. Increased hydrostatic pressure … When plasma albumin drops, the interstitial albumin concentration drops as well, therefore not markedly affecting the oncotic gradient. Kolata RJ, Burrows CF. Development of pulmonary edema (increased extravascular lung water) is a common and sometimes life-threatening clinical problem in critical-care unit patients. In: Small animal cardiovascular medicine. Decreased cardiac output leads to poor filtration by the kidneys leading to fluid accumulation within the vasculature. Rose BD, Post TW. 22. Sporer et al, in 1990s conducted a study which included 609 patients who got naloxone for opiod overdose and 4 patients subsequently developed non cardiogenic pulmonary edema(1). 2003, 44: 209-217. However, in these cases, infusion therapy has to be defensive / cautious. Med. Am. 13. Would you like to change your VIN email? North. Pulmonary leptospirosis: an excellent response to bolus methylprednisolone.Postgrad. There are bilateral pleural effusions, larger on the right than the left. This fluid collects in the numerous air sacs in the lungs, making it difficult to breathe.In most cases, heart problems cause pulmonary edema. Curr. Oops! Non-cardiogenic pulmonary edema (NCPE) is a differential that can be overlooked due to the infrequency it is diagnosed. 30 In comparison to CT scans, chest x-rays provide important information that helps rule out many pulmonary conditions at a low cost. 16. ARDS may be a complication of primary lung damage, e.g., after inhalation of toxic gas (smoke intoxication), aspiration of gastric content, inhalation of hyperbaric oxygen (oxygen intoxication) or pneumonia. Vet. Non-cardiogenic pulmonary edema is categorized depending on the underlying pathogenesis in low-alveolar pressure, elevated permeability or neurogenic edema. 8. Vet. Cardiogenic vs. noncardiogenic pulmonary edema. Fam. In cardiogenic pulmonary edema, high pulmonary capillary pressure estimated by pulmonary artery occlusion pressures is responsible for the abnormal excess fluid movement into the alveoli. J. Care. Edematous states. The ancillary features are pulmonary blood volume, peribronchial cuffing, septal lines, pleural effusions, air bronchograms, lung volume, and cardiac size. 14. 1981; 17: 219-222. With progressive specialization also in intensive care medicine and with similar large dedication of veterinarians and animal owners for time-consuming and costly treatments, more and more so-called hopeless cases may be completely cured. Thus, it is unusual to find pulmonary edema when hypoalbuminemia is the only abnormality.19, Therapeutic Principles for Pulmonary Edema, In cardiogenic pulmonary edema, the central therapeutic focus is to decrease preload by aggressive diuresis using loop diuretics. Edema develops, if one of these 4 factors is disturbed in a degree that cannot be compensated. Experimental canine leptospirosis caused by Leptospira interrogans serovars pomona and bratislava. Noncardiogenic pulmonary edema in dogs and cats: 26 cases (1987-1993). Congestive Heart Failure. The various causes, according to pathophysiology are: low alveolar pressure--postobstructive edema; low alveolar pressure--reexpansion edema; neurogenic edema; vasculitis; high altitude pulmonary edema. There is extensive, bilateral airspaces disease Although the heart is not 1975, 11: 778-783. Hrsg. Various mechanisms are responsible for non-cardiogenic edema to develop, i.e., low alveolar pressure, increased vascular permeability, increased hydrostatic pressure and a combination of these. A focused history, physical examination, echocardiography, laboratory analysis and, in some cases, direct measurement of pulmonary capillary wedge pressure can be used to distinguish cardiogenic from noncardiogenic pulmonary edema, as well … Kittleson MD. The exact identification of the underlying cause is of paramount importance for therapy and prognosis. Pathol. Pulmonary hemorrhage; Treatment. Fluid overload -- for example, kidney failure. As showed in the e-Tables, the ARDS criteria adopted were based, among others, on exclusion of cardiogenic pulmonary edema (CPE). The clinical presentation of pulmonary edema includes: 1. acute breathlessness 2. orthopnea 3. paroxysmal nocturnal dyspnea 4. foaming at the mouth 5. distress 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 tissue or blood vessels of the lung (non-cardiogenic pulmonary edema). There is bilateral, central airspace disease (white arrows), fluid in the inferior accessory fissure (red arrow) and Kerley B lines (yellow oval), all signs of congestive heart failure. Pulmonary edema is fluid accumulation in the tissue and air spaces of the lungs. 2008; 57: 499-506. Noncardiogenic pulmonary edema is caused by changes in capillary permeability as a result of a direct or an indirect pathologic insult, while cardiogenic pulmonary edema occurs due to … Noncardiogenic pulmonary edema was induced by intravenous infusion of Perilla ketone (PK). Mortality from this rare complication in people is described as 20%.3 In veterinary medicine, 2 feline cases have been described that both died.4,5. Pulmonary Alveolar Edema, CT Scan. Increased capillary permeability and changes in pressure gradients within the pulmonary capillaries and vasculature are mechanisms for which noncardiogenic pulmonary edema occurs. 2002; 65: 1823-1830. When the patient’s heart condition affects the left side of the heart, hydrostatic pressure backs up into the capillary beds su… Read the German translation: Kardiales und Nicht-Kardiales Lungenödem--Pathomechanismen und Ursachen*. Non-cardiogenic pulmonary edema is a classification of pulmonary edema where the underlying etiology is not due to left ventricular dysfunction. Common cited explanations are provided. Rosner MH. Am. Therapeutic Principles for Pulmonary Edema. Hosp. For additional information about this disease, click on this icon above. Radiol. Sedý J, Zicha J, Kunes J, Jendelová P, Syková E. Mechanisms of neurogenic pulmonary edema development. Pulmonary Alveolar Edema. Shenoy VV, Nagar VS, Chowdhury AA, Bhalgat PS, Juvale NI. Decreased alveolar pressure also results from upper airway obstruction, called postobstructive edema; e.g., in brachycephalic syndrome, laryngeal paralysis, tracheal collapse, strangulation, and iatrogenic during intubation and bronchoscopy.6-8 The non-cardiogenic edema in some hunting dogs may partially be caused by obstruction, specifically laryngeal edema associated with prolonged and constant barking. In addition, there should generally be clear radiological signs of left sided cardiac disease with distinct left atrial dilation, as well as clear clinical signs of an underlying cardiac disease that concurs with the radiograph findings.2, Pathogenesis and Causes of Non-Cardiogenic Pulmonary Edema. 2003, 14: 9-12. 10. 2009; 29: 271-281. Res. Stampley AR, Waldron DR. Reexpansion pulmonary edema after surgery to repair a diaphragmatic hernia in a cat. The three principal features are distribution of pulmonary flow, distribution of pulmonary edema, and the width of the vascular pedicle. Rationale: Acute non-cardiogenic pulmonary edema (ANPE) is a rare but challenging complication which occurs during the perioperative period, mainly before and after the extubation in the course of the recovery period of general anesthesia.It is characterized by increased fluid in extravascular pulmonary spaces, preventing gas exchange and further resulting in respiratory failure. 21. Non-Cardiogenic Pulmonary Edema. Pathogenesis and Causes of Cardiogenic Pulmonary Edema. Noncardiogenic Pulmonary Edema Aliye O. Bricker, MD Tan-Lucien H. Mohammed, MD, FCCP Key Facts Terminology Acute lung injury is general term for hypoxemic respiratory failure due to alveolar epithelial and capillary endothelial injury ARDS is subset of ALI Acute interstitial pneumonia (AIP) is idiopathic form of ARDS ARDS commonly defined by ratio of PaO2:FiO2 <… To differentiate from cardiogenic pulmonary edema, pulmonary capillary wedge pressure is not elevated and remains less than 18 mmHg. 6. Adult (acute) respiratory distress (deficiency) syndrome (ARDS). Transfusion-related acute lung injury: past, present, and future. Natriuretic peptides; Nesiritide, etc. J. For pulmonary edema to develop, essentially always an increased intravascular hydrostatic pressure or a disturbed vascular permeability is responsible. Anim. J. Vet. Cherry T, Steciuk M, Reddy VV, Marques MB. Res. Complicating factors are coagulation disturbances, perfusion disturbances and loss of surfactant. Increased capillary permeability and changes in pressure gradients within the pulmonary capillaries and vasculature are mechanisms for which noncardiogenic pulmonary edema occurs. Am. J. Noncardiogenic pulmonary edema. For just $1/month, you can help keep these videos free! This is to fix an audio issue from the original 2013 lecture. Lord PF. There are two main kinds of pulmonary edema: cardiogenic and noncardiogenic. Ead H. Review of laryngospasm and noncardiogenic pulmonary edema. In a recent human study, low dose and early application of methylprednisolone had a positive effect on the course in ARDS.21 Furthermore, extrapolated from human medicine, steroids seem useful in the pulmonary edema in leptospirosis.22. Depending on edema cause and severity, keeping an animal quiet in an oxygen-rich environment may suffice, or artificial respiration using positive end-expiratory pressure (PEEP) may be needed.20 The usefulness of glucocorticoids is controversial. Crit. J. The latter, noncardiogenic pulmonary edema (NPE), is caused by changes in permeability of the pulmonary capillary membrane as a result of either a direct or an indirect pathologic insult (see the images below). Egenvall A, Hansson K, Säteri H, Lord PF, Jönsson L. Pulmonary edema in Swedish hunting dogs. Am J Emerg Med 2004; 22:615-619. Pulmonary edema is differentiated into 2 categories: cardiogenic and noncardiogenic. 15. Nephrol. 1995; 31:133-136. Even more, in various diseases fluid therapy rather than diuresis to supportively treat the underlying disease is indicated, e.g., in sepsis, pancreatitis and leptospirosis. Noninvasive Ventilation and Mortality in Acute Cardiogenic Pulmonary Edema While several randomized trials and meta-analyses demonstrate that NIV in acute cardiogenic pulmonary edema (ACPE) reduces the need for intubation and improves respiratory parameters (e.g. *Published in Schweiz. Kerley B Lines, Congestive Heart Failure. The pathophysiology of the syndrome is not well understood. The disease process has multiple etiologies, all of which require prompt recognition and intervention. Radiography of the cardiovascular system; heart failure. Am. 3. J. Cardiogenic edema pathogenically is caused by elevated hydrostatic pressure in the pulmonary capillaries due to left sided congestive heart failure. The prognosis even with intensive supportive care is poor.15 Pulmonary edema similar to ARDS can be elicited by multiple blood transfusions; even though this complication is life threatening, the prognosis is much better than in ARDS.14,16, A further important cause of protein-rich pulmonary edema is vasculitis and disturbed vascular permeability, in dogs well recognized in leptospirosis.17 This may be complicated by prognostically important pulmonary hemorrhages, that may not be differentiated radiologically from edema.18. Soderstrom MJ, Gilson SD, Gulbas N. Fatal reexpansion pulmonary edema in a kitten following surgical correction of pectus excavatum. In cardiogenic pulmonary edema, the central therapeutic focus is to decrease preload by aggressive diuresis using loop diuretics. Decreased alveolar pressure develops after fast removal of pleural effusion, pneumothorax, or lung lobes, called reexpansion edema. Pulmonary edema is a condition caused by excess fluid in the lungs. Johann Lang, Prof., Dr. med. Drobatz KJ, Saunders HM, Pugh CR, Hendricks JC. 2005; 66: 1816-1822. CPE reflects the accumulation of fluid with a low-protein content in the lung interstitium and alveoli as a result of cardiac dysfunction (see the image below). Coronary artery disease with left ventricular failure. Am. 1996; 208: 1428-1433. Arch. No Pulmonary Edema in Low Oncotic Pressure, Even though oncotic pressure, primarily depending on plasma albumin concentration, is one of the important factors to keep fluid inside the vasculature, it does not play an important role in the lungs. 17. J. Hosp. In contrast, the various mechanisms of non-cardiogenic edema are not affected by diuresis. The physiological fluid movement through a vascular membrane into the surrounding tissue depends on 3 factors: membrane permeability, oncotic pressure gradient and hydrostatic pressure gradient. J. Clin. Most important diseases are acquired, advanced degenerative mitral valve disease and dilated cardiomyopathy, and congenital, patent ductus arteriosus. minor fissure (blue arrow) and bilateral pleural effusions (ref arrows). There is bilateral, almost-symmetrical perihilar airspace disease (with air bronchograms). Vet. Perina DG. Cardiogenic pulmonary edema and non-cardiogenic pulmonary edema, with the exception of ARDS, can resolve within hours to several days; Cardiogenic pulmonary edema is usually treated with a combination of Oxygen; Diuretics; Lasix, etc. Continued Pulmonary Edema Causes. The exact differentiation and diagnosis is made based on a combination of clinical and radiological findings and considerations. Firdose R, Elamin EM. Physician. Assoc. 4. Small. Med. Baumann D, Flückiger M. Radiographic findings in the thorax of dogs with leptospiral infection. The main findings in cardiogenic pulmonary edema are ground-glass opacities, thickening of major fissures, interstitial edema and interlobular, peribronchovascular and interstitial thickening. When the rise in pressure is gradual, pressure may exceed 20 mmHg before pulmonary edema develops, because the capacity of lymphatic drainage can be increased.1 For cardiogenic pulmonary edema to develop, by definition there must be left-sided congestive heart failure for which there must be an identifiable underlying cardiac disease. Pathophysiologically, excessive sympatho-adrenergic activation in the medulla oblongata plays the central role. Non-cardiogenic pulmonary edema occurs due to increased vascular permeability secondary to direct or indirect lung damage. The primary supportive measure is optimized oxygenation. In contrast, the various mechanisms of non-cardiogenic edema are not affected by diuresis. A further important cause of non-cardiogenic edema is neurogenic edema. Assoc. Many causes of NPE exist, including drowning, acute glomerulonephritis, fluid overload, aspiration, inhalation injury, neurogenic pulmonary edema, allergic reaction, and adult respiratory distress syndrome (ARDS). It may also be known as neurogenic pulmonary edema. Am. Nitrates; Nitroglycerin, etc. B. In: Clinical Physiology of Acid-Base and Electrolyte Disorders. Greenlee JJ, Alt DP, Bolin CA, Zuerner RL. In: Small animal cardiovascular medicine. A patient suffering from cardiogenic pulmonary edema has a primary problem with its heart, which in turn reduces stroke volume. Physiol. Neurogenic pulmonary edema in the dog. For clinical purposes, pulmonary edema is grossly divided based on pathophysiology in cardiogenic and non-cardiogenic edema. This results in pulmonary venous constriction shifting blood from the systemic to the pulmonic circulation, increase in pulmonary hydrostatic pressure and finally edema.10 Causes described in dogs are brain trauma, epileptic seizures, and electrocution.6,11,12 The pulmonary edema in hunting dogs during or after the hunt is also thought to be caused by excessive catecholamine secretion, and thus to be a neurogenic edema.9 A particular pathogenesis of neurogenic pulmonary edema is the one in endurance athletes caused by cerebral edema elicited by hyponatremia.13 Prognosis for complete recovery in neurogenic edema is good with adequate supportive care. Opin. (adsbygoogle = window.adsbygoogle || []).push({}); Cardiogenic and Non-cardiogenic … Finally, high altitude above around 3000 m may cause non-cardiogenic pulmonary edema in susceptible individuals. 5. Tierheilk. 2. Dynamics. We read with interest the article by Sjoding et al1 in a recent issue of CHEST (February 2018). Quizlet flashcards, … Am. 2010;16: 62-68. In order to understand non-cardiogenic pulmonary edema, one needs to know how it differs from cardiogenic pulmonary edema (CPE). "Flash" pulmonary edema is a term that is used to describe a particularly dramatic form of cardiogenic alveolar pulmonary edema. Acute respiratory distress syndrome. Cardiogenic pulmonary edema. ACPE is defined as pulmonary edema with increased secondary hydrostatic capillary pressure due to elevated pulmonary venous pressure. Assoc. In cardiogenic pulmonary edema, the central therapeutic focus is to decrease preload by aggressive diuresis using loop diuretics. Vet. Multiple, thin, short, white lines which are perpendicular to the chest wall at the lung base are seen (white oval) representing fluid which has leaked into the interlobular septae as a result of congestive heart failure, one of the signs of CHF. Med. Pathophysiology of heart failure. Pharmacological treatments for acute respiratory distress syndrome. Anim. In contrast, the various mechanisms of non-cardiogenic edema are not affected by diuresis. Radiologically, congestion is manifested by dilated pulmonary veins and cardiogenic edema that in dogs initially is characterized by an increased interstitial lung pattern progressing to an alveolar pattern. The pulmonary interstitial space normally has a higher albumin concentration than other interstitial tissue and a small oncotic gradient, because the permeability of pulmonary capillaries is higher than in other capillaries. The pathogenesis is postulated to be due to increased catecholamine mediated vasoconstriction which causes fluid shift into pulmonary vascular bed(2). Hrsg. 12. Assoc. Generally, divided into cardiogenic and non-cardiogenic categories. Pulmonary Edema. In summary, cardiogenic and non-cardiogenic causes are responsible for pulmonary edema to develop. There is extensive, bilateral airspaces disease with fluid in the vet., DECVDI. 2006; 82: 602-606. Cardiogenic pulmonary edema develops secondary to a rise of hydrostatic pressure in the pulmonary capillaries (normal <12 mmHg). MD Kittleson, RD Kienle, Mosby, St. Louis, 1998, 136-148. Am. J. ARDS may also be a complication of a severe systemic disease, like sepsis, extensive burn and acute pancreatitis. Kittleson MD. Many cases are probably diagnosed as cardiogenic edema, because dyspnea and edema are associated with exercise or a stress situation, e.g., in laryngeal paralysis or edema associated with anesthesia, or because affected animals may have two concomitant diseases, e.g., tracheal collapse and degenerative mitral valve disease. MD Kittleson, RD Kienle, Mosby, St. Louis, 1998, 67-69. More likely in these dogs is a neurogenic edema associated with a very high catecholamine level (see below).9 Postobstructive pulmonary edema in dogs and cats is probably much more common than diagnosed. Cardiogenic pulmonary edema (CPE) should be differentiated from pulmonary edema associated with injury to the alveolar-capillary membrane, caused by diverse etiologies. 11. Hosp. There are three principal causes: cardiac failure, overhydration, and increased pulmonary capillary permeability. Beng ST, Mahadevan M. An uncommon life-threatening complication after chest tube drainage of pneumothorax in the ED. J. Anim. Obstructing valvular lesions -- for example, By drainage of a large pleural effusion with thoracentesis, Of the lung collapsed by a large pneumothorax, Disseminated intravascular coagulopathy (DIC), Pulmonary edema associated with severe respiratory distress, Cyanosis refractory to oxygen administration, Lower pulmonary capillary wedge pressure (PCW < 18mm Hg) than cardiogenic pulmonary edema, Most patients who survive have normal-appearing lungs, Some patients develop pulmonary fibrosis, Radiographic findings can lag behind physiologic changes, Seen at the lung bases, usually no more than 1 mm thick and 1 cm long, perpendicular to the pleural surface, Usually bilateral, frequently the right side being larger than the left, Thickening of the major or minor fissure, Visualization of small doughnut-shaped rings representing fluid in thickened bronchial walls, Collectively, the above four findings comprise, When the fluid  enters the alveoli themselves, the airspace disease is typically diffuse, and there are no air bronchograms, Bilateral, peripheral air space disease with air bronchograms or central bat-wing pattern, Kerley B lines and pleural effusions are uncommon, Typically occurs 48 hours or more after the initial insult, Stabilizes at around five days and may take weeks to completely clear, Gravity-dependent consolidation or ground glass opacification, Cardiogenic pulmonary edema and non-cardiogenic pulmonary edema, with the exception of ARDS, can resolve within hours to several days, Cardiogenic pulmonary edema is usually treated with a combination of, Angiotensin converting enzyme (ACE) inhibitors. Hrsg. Of big importance for the development of non-cardiogenic edema is the acute (formerly adult) respiratory distress syndrome, ARDS.14 The underlying cause is severe and diffuse damage of the lung parenchyma resulting in endothelial and epithelial disturbance of permeability and exit of protein rich fluid. Anim. 2001; 42: 305-307. Cardiogenic and Noncardiogenic Pulmonary Edema study guide by walter117 includes 22 questions covering vocabulary, terms and more. Assoc. Pulmonary edema secondary to dynamic tracheal collapse. Acute cardiogenic pulmonary edema (ACPE) is a common cardiogenic emergency with a quite high in-hospital mortality rate. They found “moderate” interobserver agreement among clinicians in diagnosing ARDS using Berlin's criteria. Multiple disease processes can lead to a similar pulmonary response. 9. Semin. J. Bronchology 2004; 11: 118-121. Clin. Exercise-associated hyponatremia. Am. 19. Med. Emerg. Mortelliti MP, Manning HL. Please enter a valid Email address! Med. This type is … , Bolin CA, Zuerner RL is bilateral, almost-symmetrical perihilar airspace disease ( with air )... In a cat.push ( { } ) ; cardiogenic and noncardiogenic common cardiogenic emergency a! A cat parent C, King LG, Van Winkle TJ, Walker LM comparison to CT,! '' pulmonary edema due to increased capillary hydrostatic pressure in the tissue and air spaces of syndrome! Marques MB decreased alveolar pressure develops after fast removal of pleural effusion,,... Md Kittleson, RD Kienle, Mosby, St. Louis, 1998, 136-148 disease process has multiple,! 2001, 478-534 past, present, and increased pulmonary capillary wedge pressure is due. Translation: Kardiales und Nicht-Kardiales Lungenödem -- Pathomechanismen und Ursachen * its heart, in. The predisposing condition should be treated E. mechanisms of non-cardiogenic edema are not affected by diuresis a combination of and! Clinical and radiological findings and considerations Gilson SD, Gulbas N. 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As a consequence of some coexisting clinical condition, either systemic or pulmonary be defensive / cautious coexisting condition! Not elevated and remains less than 18 mmHg parent C, King LG, Van Winkle,... Be a complication of a severe systemic disease, like sepsis, extensive burn and acute.. Pulmonary conditions at a low cost D, Flückiger M. Radiographic findings in tissue..., Van Winkle TJ, Walker LM ( normal < 12 mmHg ) cherry T, Steciuk,! Be due to increased vascular permeability secondary to direct or indirect lung damage ( adsbygoogle = window.adsbygoogle || [ ).

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