IPLab:Lab 4:Pulmonary Congestion and Edema

Clinical Summary

This 67-year-old male was hospitalized because of extensive atherosclerotic cardiovascular disease. Following surgery, during which diseased portions of the femoral arteries were bypassed, he developed massive pulmonary embolization and expired.

At autopsy, thrombi were found in the femoral and iliac veins, as well as in the larger pulmonary arteries.

Images

• 
  This is a gross photograph of lungs that are distended and red. The reddish coloration of the tissue is due to congestion. Some normal pink lung tissue is seen at the edges of the lungs (arrows).
• 
  This is a gross photograph of lung demonstrating acute pulmonary congestion and edema. A frothy exudate fills the bronchus (arrow).
• 
  This gross photograph demonstrates the frothy exudate that is being extruded from the lung tissue.
• 
  This is a low-power photomicrograph of lung from this case. The lung section has a pale-red color indicating proteinaceous material within the lung.
• 
  This is a higher-power photomicrograph of lung. The edema fluid within the alveoli is visible at this higher magnification (arrows). The thickened pleura (1) is on the left.
• 
  This is a higher-power photomicrograph showing edema-filled alveoli in the right portion of this section (arrows).
• 
  This high-power photomicrograph illustrates the edema fluid within the alveoli (1) and the congestion (RBCs) in the alveolar capillaries (arrows).

Study Questions

• Name two types of edema fluid.

Inflammatory edema has a higher protein content (specific gravity > 1.020) and is associated with an inflammatory reaction. Noninflammatory edema is caused by alterations in hemodynamic forces across the capillary wall (hemodynamic edema).

• Define the following:

• anasarca

Anasarca: severe and generalized edema which includes marked swelling of the subcutaneous tissues.

• hydrothorax

Hydrothorax: fluid build-up in the thorax.

• hydropericardium

Hydropericardium: fluid build-up in the pericardial sac.

• hydroperitoneum

Hydroperitoneum: fluid accumulation in the abdominal cavity--also referred to as ascites.

• What is the most common cause of pulmonary edema?

Left-sided heart failure.

Additional Resources

Reference

• eMedicine Medical Library: Heart Failure
• Merck Manual: Heart Failure (HF)

Journal Articles

• Welch TD, Yang EH, Reeder GS, Gersh BJ. Modern management of acute myocardial infarction. Curr Probl Cardiol 2012 Jul;37(7):237-310.

Images

• PEIR Digital Library: Pulmonary Edema Images
• WebPath: Lung Pathology

Related IPLab Cases

• Lab 1: Heart: Myocardial Infarction (Coagulative Necrosis)
• Lab 3: Heart: Acute Myocardial Infarction
• Lab 3: Heart: Healed Myocardial Infarction
• Lab 4: Heart: Mural Thrombus
• Lab 4: Coronary Artery: Thrombosis

Pulmonary congestion is the engorgement of pulmonary vessels with blood. The increased pressure caused by this engorgement leads to transudation of fluid through the capillary walls and into the alveolar and interstitial spaces.