Pulmonary oedema in the emergency room: what is hidden beyond an apparently common presentation

Abstract

Cardiogenic flash pulmonary oedema is a common and potentially fatal cause of acute respiratory distress. Although it often results from acute decompensated heart failure, abrupt-onset aortic regurgitation can sharply rise cardiac filling pressure and, consequently, pulmonary venous pressure, leading to rapid fluid accumulation in the interstitial and alveolar spaces. We report a case of a 64-year-old woman admitted to the emergency department with a flash pulmonary oedema; a careful clinical investigation subsequently revealed a rare aetiology for this 'common' presentation. After a detailed auscultation that unmasked a diastolic cardiac murmur, an acute severe aortic insufficiency was further confirmed by echocardiography, showing inflammation and thickening of the entire aorta wall. The patient was submitted to valve replacement surgery, and histological examination, to our surprise, showed features of aortitis, remarkable for the presence of giant cells. A diagnosis of idiopathic aortitis versus inaugural giant cell arteritis was proposed and treatment started with corticosteroids.

Flash pulmonary edema in the cardiac catheterization laboratory: A case report

“…(4) In a case report by Catrina Patrício et al in 2014, a 64-year-old woman was reported who was admitted to the emergency department with FPE due to acute severe aortic insufficiency. (8) FPE may develop in the cardiac catheterization laboratory at any time during the procedure. The diagnosis of FPE is based on clinical evaluation.…”

Intravenous furosemide vs nebulized furosemide in patients with pulmonary edema: A randomized controlled trial

“…Pulmonary edema (PE) is defined as pathological accumulation of fluid in the extravascular space 1 . PE is one of the most emergencies that physicians are faced with it in the emergency department 2 . The most important manifestation of PE is fluid from pulmonary capillaries into the alveolar cavity through the alveolar–capillary membrane 3 …”

“…1 PE is one of the most emergencies that physicians are faced with it in the emergency department. 2 The most important manifestation of PE is fluid from pulmonary capillaries into the alveolar cavity through the alveolar-capillary membrane. 3 PE will ultimately lead to defects in gas exchange and may cause respiratory failure.…”