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Pulmonary Edema - Diagnosis and tests


Physical examination

Pulmonary edema requires prompt treatment, you'll initially be diagnosed on the basis of your symptoms and a physical exam, electrocardiogram and chest X-ray.
Doctor will listen to your lungs and heart with a stethoscope to check for:
  • Abnormal heart sounds
  • Crackles in your lungs, called rales
  • Increased heart rate (tachycardia)
  • Rapid breathing (tachypnea)
  • Other things that may be seen during the exam include:
  • Leg or abdominal swelling
  • Abnormalities of your neck veins (which can show that there is too much fluid in your body)
  • Pale or blue skin color (pallor or cyanosis)

Tests that may be done to diagnose pulmonary edema or to determine why you developed fluid in your lungs include:

Chest X-ray

Pulmonary edema is typically diagnosed by a chest X-ray. A normal chest radiograph (X-ray) consists of a central white area pertaining to the heart and its main blood vessels plus the bones of the vertebral column, with the lung fields showing as darker fields on either side, enclosed by the bony structures of the chest wall.
A typical chest X-ray with pulmonary edema may show a more white appearance over both lung fields than usual. More severe cases of pulmonary edema can demonstrate significant opacification (whitening) over the lungs with minimal visualization of the normal lung fields. This whitening represents filling of the alveoli as a result of pulmonary edema, but it may give minimal information about the possible underlying cause.
To identify the cause of pulmonary edema, a thorough assessment of the patient's clinical picture is essential. A careful medical history and physical examination often provide invaluable information regarding the cause. Pulse oximetry. In pulse oximetry, a sensor attached to your finger or ear uses light to determine how much oxygen is in your blood.

Blood tests.

You may have blood drawn, usually from an artery in your wrist, so that it can be checked for the amount of oxygen and carbon dioxide it contains (arterial blood gas concentrations).
Your blood may also be checked for levels of a substance called B-type natriuretic peptide (BNP). Increased levels of BNP may indicate that your pulmonary edema is caused by a heart condition.
Other blood tests may be done — including tests of your kidney function, thyroid function and blood count — as well as tests to exclude a heart attack as the cause of your pulmonary edema.

Electrocardiogram (ECG).

This noninvasive test can reveal a wide range of information about your heart. During an ECG, patches attached to your skin receive electrical impulses from your heart. These are recorded in the form of waves on graph paper or a monitor. The wave patterns show your heart rate and rhythm and whether areas of your heart show diminished blood flow.

Echocardiogram.

An echocardiogram is a noninvasive test that uses a wand-shaped device called a transducer to generate high-frequency sound waves that are reflected from the tissues of your heart. The sound waves are then sent to a machine that uses them to compose images of your heart on a monitor.

Transesophageal echocardiography (TEE).

In a traditional cardiac ultrasound exam, the transducer remains outside your body on the chest wall. But in TEE, a doctor inserts a soft, flexible tube (catheter) with a transducer attached to the tip through your mouth and guides it into your esophagus — the passage leading to your stomach.

Pulmonary artery catheterization.

If other tests don't reveal the reason for your pulmonary edema, your doctor may suggest a procedure to measure the pressure in your lung capillaries (wedge pressure).

Cardiac catheterization.

If tests such as an ECG or echocardiography don't uncover the cause of your pulmonary edema, or you also have chest pain, your doctor may suggest cardiac catheterization and coronary angiogram.

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