Pulmonary edema, etiology and therapy.
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Pulmonary edema, a serious complication of pregnancy and the puerperium, can result in maternal and fetal morbidity and mortality. Pulmonary edema in pregnancy can be categorized by the primary mechanisms from which it results. An analysis of lung physiology using the Starling equation suggests that increased hydrostatic pressure, increased permeability, and osmotic imbalance can all lead to the development of pulmonary edema. These factors explain many of the common settings of pulmonary edema, including preeclampsia, tocolysis, and cardiac disease. This article will discuss the etiology and pathophysiology of pulmonary edema, how pregnancy influences it, and issues in its management.
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To assess the value of the chest radiograph in differentiating various types of pulmonary edema, we retrospectively analyzed 119 films of patients with pulmonary edema caused by left heart decompensation (group 1;N = 56), renal failure (group 2; N = 19), and lung microvascular injury (group 3; N = 44). Chest radiographs were examined independently by two trained observers, unaware of the clinical diagnosis, according to a standardized reading table. The two observers assigned chest films to the corresponding group with an accuracy of 86% and 90%, respectively. To test the observers' objectivity, we used radiographic findings as input variables for discriminant analysis. Computer-generated numerical functions identified pulmonary edema etiology with an accuracy of 88% when considering the three groups together. When groups were compared as pairs, percentages of correct classification were 91% (group 1 vs. group 2), 93% (group 1 vs. group 3), and 100% (group 2 vs. group 3). Thus, a standardized reading of chest radiographs may be considered a reliable clinical method for identifying pulmonary edema etiology.
Ultrasonography has gained an important role for the diagnosis of acute and chronic scrotal lesions. We report our experience on 6 cases of acute scrotal edema. The etiology of edema was congestive cardiopathy (two patients), glomerulonephrosis (three patients) and lumboaortic lymphnode metastases from bladder transitional cell carcinoma (one patient). Ultrasound scan scrotal appearances were similar in all examined patients, and the only pathologic findings observed were "onion" like appearance and a thickened scrotal wall. Therefore, to define acute scrotal edema etiology, it isn't enough an ultrasound examination, but it's necessary to extend the ultrasound scan assessment to other organs.
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