Pulmonary Oedema and pulmonary congestion

Question 1

Excessive interstitial fluid in the alveoli.

Answer 1

Pulmonary oedema

Question 2

The pulmonary oedema commonly occur where first?

Answer 2

Common, occurs first in the basal regions of the lung lower lobes (dependent oedema)

Question 3

The alveoli in the pulmonary oedema is filled with what?

Answer 3

Smooth to slight floccular pink material characteristics of pulmonary oedema.

Question 4

The capillaries in alveoli become what in pulmonary oedema?

Answer 4

Congested filled with many red blood cells (RBCs).

Question 5

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Pulmoary congestion with oedema is common in patients with?

Answer 5

Heart failure (Elevated B-type natriuretic peptide)+ In areas inflammation of the lunvg

Question 6

what happens in pulmnoary congestion ?

Answer 6

Dilated capillaries and leakage of bood into alveolar spaces

Question 7

Histology of pulmonary congesion and pulmonary oedema

Answer 7

Engorged alveolar capillaries, intra-alveolar finely granular pink transudative material, haemosiderin-laden macrophages (‘heart failure cells’). RBC breakdown results in brown cytoplasmic hemosiderin granules
If long-standing, fibrosis and thickening of the alveolar walls with numerous haemosiderin-laden macrophages result in a grossly firm brown-coloured lung (‘brown induration’)

Question 8

What causes pulmonary oedema

Answer 8

Increased hydrostatic pressure: Increased pulmonary venous pressure from left-sided heart failure, volume overload or pulmonary vein obstruction
* Decreased oncotic pressure: Less common e.g. hypoalbuminemia, nephrotic syndrome, liver disease, protein-losing enteropathies
Oedema due to alveolar wall injury
* Direct injury: Damage from infections e.g. bacterial pneumonia, inhaled gases, liquid aspiration, radiation, lung trauma
* Indirect injury: Systemic inflammatory response syndrome, drugs/chemicals
Major component of acute respiratory distress syndrome
Damage to either alveolar microvasculature or epithelium results in an inflammatory exudate starting in the interstitium and in severe cases, extends into the alveoli.

Question 9

What is meant by sequelae

Answer 9

1. Impairs respiratory function
2. Predisposes to infection