Pulmonary Edema

Pulmonary edema is an unexpected buildup of fluid in your lungs. “Pulmonary” means it has to do with your lungs. “Edema” means too much fluid causes swelling.

Your lungs consist of many tiny air sacs (alveoli). In healthy lungs, the alveoli inflate with air when you breathe in (inhale). Oxygen from the air moves into your blood. When you breathe out (exhale), your lungs push out carbon dioxide. They remove the carbon dioxide from your blood. But if you have pulmonary edema (pronounced “PUHL-muh-ner-ee” “ih-DEE-muh”), the alveoli fill with fluid instead of air. The fluid can block your blood from getting oxygen. This can cause you to have trouble breathing.

It’s very common and can be serious. Treatment often includes oxygen therapy.

Types

Pulmonary edema may be:

• Cardiogenic: A heart problem causes it. When your heart stops pumping blood correctly, blood backs up into your lung’s blood vessels. As pressure in your blood vessels increases, it pushes fluid into the alveoli. Most cases of pulmonary edema are cardiogenic.
• Noncardiogenic: A condition that doesn’t relate to heart problems causes inflammation or injury to the blood vessels in your lungs. The blood vessels leak, and fluid goes into your alveoli.

It can also develop suddenly (acute pulmonary edema) or take a long time to develop (chronic pulmonary edema).

Symptoms of pulmonary edema

If you have acute pulmonary edema, you may have symptoms like:

• Shortness of breath (dyspnea), which may occur during movement or when you’re lying down
• Coughing, sometimes with blood or frothy mucus
• Wheezing
• Gasping for air
• Feeling like you’re suffocating
• Chest tightness or pain

Chronic pulmonary edema shares many of the same symptoms as acute pulmonary edema. But the symptoms may be milder. You may have symptoms like:

• Breathlessness that wakes you up when you’re sleeping
• Swelling in your legs
• Feeling very tired (fatigue)
• Decreased ability to get physical activity

Call 911 or go to the emergency room (ER) if you have trouble breathing.

What is the typical cause?

It depends on whether a heart problem or another condition causes it.

The most common cause of cardiogenic pulmonary edema is congestive heart failure. Congestive heart failure that leads to pulmonary edema can result from:

• Heart attack
• Weakened heart muscles (cardiomyopathy)
• Narrowed or leaky heart valves (valvular heart disease)
• High blood pressure (hypertension)
• Abnormal heart rhythm (arrhythmia)
• Heart muscle inflammation (myocarditis)
• Fluid in the lining around your heart (pericardial effusion)

Cardiogenic pulmonary edema can also happen when fluid buildup from other causes overwhelms the heart. The most common example is chronic kidney disease (CKD).

The main cause of noncardiogenic pulmonary edema is adult respiratory distress syndrome (ARDS). ARDS is a lung injury that causes fluid buildup in your lungs. Other causes may include:

• Blood clot in your lungs (pulmonary embolism)
• Breathing in smoke
• Altitude sickness
• Aspirin poisoning
• Opioid overdose
• Near drowning
• Viral infections, including dengue virus and hantavirus pulmonary syndrome
• Blood clot in your lungs (pulmonary embolism)
• Blockage in your upper airways (negative pressure pulmonary edema)
• Head trauma or a seizure (neurogenic pulmonary edema)
• Blood transfusion reaction (transfusion-related acute lung injury)

Risk factors

You’re at a greater risk of pulmonary edema if you have heart problems that increase pressure in your heart. Some risk factors include:

• Drinking alcohol or using tobacco products or cocaine
• Not getting enough physical activity
• Being 65 or older
• Eating foods that have a lot of fat or salt
• A biological family history of heart problems

Complications

Pulmonary edema complications may include:

• High blood pressure in your lungs (pulmonary hypertension)
• Heart failure
• Trouble breathing or low oxygen levels
• Swelling, especially in your feet, legs and stomach
• Fluid buildup around your lungs (pleural effusion)
• Liver problems

How do you know if you have fluid in your lungs?

Your provider will first review your health history and ask about your symptoms. They’ll also recommend a physical exam. It includes listening to your heart and lungs with a stethoscope (auscultation). They’ll look for:

• Increased or decreased heart rate or blood pressure
• Increased number of breaths you take per minute (respiratory rate)
• Abnormal heart sounds
• Wheezing/whistling or crackling sounds in your lungs
• Swelling
• Skin discoloration (gray, purple or blue)

If they think you may have pulmonary edema, they’ll recommend more tests to make an official diagnosis:

• Blood tests
• Pulse oximetry to check your blood oxygen levels
• Chest X-ray to see if there’s fluid in your lungs
• CT scan to get a more detailed look at your lungs
• Echocardiogram to check for abnormal heart activity
• Electrocardiogram (EKG) to check for heart rhythm problems or a heart attack
• Cardiac catheterization to check for blockages in your coronary arteries
• Ultrasound of your chest to look for fluid buildup around your lung

How is it treated?

Your treatment may include:

• Oxygen therapy, either through prongs in your nose or a mask over your mouth and nose
• Extra air pressure given through a mask (CPAP or BiPAP)
• Mechanical ventilation if you can’t breathe on your own
• Diuretics (water pills), which help you pee more and decrease pressure
• Blood pressure medications to help control your blood pressure
• Inotropes to help treat heart failure
• Heart surgery to fix leaky or narrowed valves

Recovery time

Your recovery depends on the type of pulmonary edema, how severe it is and what’s causing it. With successful treatment, your lungs should recover within six months to a year. They may recover even sooner. Your healthcare provider will give you a better idea of what to expect.

When should I see my healthcare provider?

Call 911 or go to the nearest ER if you have sudden pulmonary edema symptoms like:

• Difficulty breathing
• Chest tightness or pain
• Coughing up blood

It’s important to schedule follow-up appointments as part of your treatment. Your provider will make sure your lungs are performing as well as they should.

What can I expect if I have pulmonary edema?

Your outlook depends on many different factors, including:

• The type you have
• Whether it develops quickly or over time
• Your age and overall health
• If you have any other underlying health conditions

Early diagnosis and treatment are very important. You may need to stay at the hospital for a little while. You may also need treatment in the intensive care unit (ICU). But even with treatment, pulmonary edema can be fatal. Your healthcare provider will give you a better idea of what to expect.

What is swimming-induced pulmonary edema?

This is when people who spend a lot of time doing water activities — like competitive swimmers and divers — develop lung injuries because their lung capillaries burst. Capillaries are delicate blood vessels that transport nutrients and oxygen to cells. They also carry away tissue waste, including carbon dioxide.

If you have swimming-induced pulmonary edema (SIPE), when you dive, blood goes from your legs and abdomen to your lungs. The extra blood increases pressure in your capillaries. They leak, and the fluid goes into the air sacs in your lungs.