Role of Pulmonary Lymphatics in Chronic Pulmonary Edema

Abstract

Clinically, the development of pulmonary edema is frequently associated with an elevation of left atrial pressure. 1 However, overt pulmonary edema does not always occur with such pressure elevations, even when the plasma oncotic pressure is greatly exceeded. 2 It is conceivable that a dilatation of the pulmonary lymphatic system might remove fluid from the lung and prevent, or delay, the development of overt pulmonary edema. In experimental studies on the dog, it has been demonstrated that lymph flow from the lungs increased with an acute elevation of the pulmonary venous pressure 3 " 6 ; however, the quantity of lymph was small and apparently ineffective in preventing the development of pulmonary edema. The critical question, however, of the extent of the pulmonary lymph flow in chronic pulmonary edema remained unanswered. It was the purpose of the current study to determine what i*ole, if any, the lymphatics play in the prevention of chronic pulmonary edema. MethodsMongrel dogs were used in this study. The aninuils were anesthetized with intravenous sodium pentobnrbitnl (29 mg./Kg.), and a side-to-side 5 to 15-min. aorticocuvnl anastomosis was made immediately below the renal vessels by approximating and suturing the aorta and vena cava. Dogs not surviving moro than one month were excluded from the study. Thirty animals not included iu the experimental group were used for preliminary

Lung Water in Patients with Acute Myocardial Infarction

“…Impairment of the pulmonary lymphatic drainage may contribute to the accumulation of excessive fluid in the interstitial and alveolar spaces. 28 29 We have no information regarding the contribution of lymphatic obstruction to the elevation of PEV in our patients.…”

Mediastinal Lymphadenopathy in Patients Undergoing Cardiac Transplant Evaluation

“…The study was approved by the Medical University of South Carolina Institutional Review vessels are located in the connective tissue of the interlobular septa, the peribronchial sheath, and the pleura. 5 Fluid fl ows through the lymphatic system and drains into the venous circulation. Patients with CHF have chronically elevated left-and occasionally rightsided fi lling pressures leading to increased fl uid clearance pathways (ie, the lymphatic system), which drain the lung parenchyma as a compensatory mech anism.…”

The relationship between right duct lymph flow and extravascular lung water in dogs given alpha-naphthylthiourea.

“…Thus, lymph flow in each experiment remained relatively constant during the period of observation. Right duct lymph was successfully collected in 13 of the last 22 consecutive attempts (59%).…”

“…The lung has an extensive lymphatic network and, in the 30 years since the pioneering work of Warren and Drinker (2), the flow and composition of pulmonary lymph have been described in normal dogs and in dogs with various conditions associated with increased extravascular lung water (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). However, the factors which govern pulmonary lymph drainage are not fully understood.…”