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BMC Pulm Med 2022 Mar 31;22(1):118. Epub 2022 Mar 31.

Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China.

Background: Noncardiogenic pulmonary edema (NCPE) is a rare and life-threatening allergy-like reaction to the intravascular injection of a nonionic radiographic agent. We first describe a very rare case of fatal NCPE after the intravenous injection of nonionic, iso-osmolar iodine contrast media. Case presentation A 55-year-old male patient was admitted to the hospital with esophageal cancer. Read More

Case Rep Crit Care 2021 11;2021:8895319. Epub 2021 Aug 11.

Department of Surgery, Kendall Regional Medical Center, 11750 SW 40th Street, Miami, Florida 33175, USA.

HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a rare but serious complication of pregnancy characterized by hemolytic anemia, elevated liver enzymes, and thrombocytopenia. It occurs in <1% of all pregnancies with 70% of cases developing before delivery, the majority occurring between the 27 and 37 weeks of gestation. Respiratory failure seen in HELLP syndrome clinically and radiographically appears similar to acute respiratory distress syndrome (ARDS), with presence of bilateral pulmonary opacities on imaging as well as persistent hypoxemia requiring elevated ventilator requirements. Read More

J Craniofac Surg 2021 Jul-Aug 01;32(5):e421-e423

Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey.

Abstract: Negative pressure pulmonary edema (NPPE) is a form of noncardiogenic pulmonary edema that typically occurs in response to an upper airway obstruction, where patients generate high negative intrathoracic pressures, leading to a pulmonary edema especially in the postoperative period. Here, we report a case of NPPE following general anesthesia that can easily be misdiagnosed as COVID-19 both radiologically and clinically during this pandemic. Twenty-year-old male was presented with sudden onset respiratory distress, tachypnea, and cyanosis just after the rhinoplasty surgery under general anesthesia. Read More

Indian J Radiol Imaging 2020 Jan-Mar;30(1):20-26. Epub 2020 Mar 30.

Department of Radiodiagnosis, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Chemotherapy while revolutionizing cancer management by improving survival and quality of life; is also associated with several adverse effects. Lung is the most common organ affected in chemotherapy-related complications, due to either drug toxicity or more commonly due to infections caused by immunosuppression and less commonly due to immune-mediated injury. Radiology, when used in combination with clinical and lab data, can help reach the specific diagnosis or narrow down the differentials. Read More

J Cardiothorac Vasc Anesth 2021 Jan 5;35(1):310-322. Epub 2019 Dec 5.

Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.

Today, proficiency in cardiopulmonary ultrasound is considered essential for anesthesiologists and critical care physicians. Conventional 2-dimensional images, however, do not permit optimal characterization of specific conditions (eg, diaphragmatic paralysis, major atelectasis, and pneumothorax) that may have relevant clinical implications in critical care and perioperative settings. By contrast, M-mode (motion-based) ultrasonographic imaging modality offers the highest temporal resolution in ultrasonography; this modality, therefore, can provide important information in ultrasound-driven approaches performed by anesthesiologists and intensivists for diagnosis, monitoring, and procedural guidance. Read More

Intern Med 2019 Sep 7;58(18):2731-2735. Epub 2019 Jun 7.

Department of General Medicine, Saga University Hospital, Japan.

A 64-year-old Japanese woman developed fatigue, dyspnea, and wheezing in July. Although she had been undergoing treatment for chronic obstructive pulmonary disease for six days, she was transferred to our hospital with delirium and diarrhea. On admission, she had an eschar of 3 mm in diameter on her anterior chest. Read More

HSS J 2019 Feb 7;15(1):76-83. Epub 2018 Dec 7.

2UHealth Sports Medicine Institute, University of Miami Miller School of Medicine, Miami, FL USA.

Amid growing concern about the misuse of prescribed opioids, the rising rates of opioid use disorder, and the use of illicit opioids, clinicians in ambulatory, inpatient, and operative environments are encountering opioid-related complications in their patients. These complications can affect multiple organ systems including cardiovascular, pulmonary, gastrointestinal, and neurologic and are related to excess opioid levels in the body or contamination from non-sterile injection. It is important for the orthopedic surgeon to have a general understanding of the pathologies associated with opioid use disorder and their appearance on diagnostic imaging. Read More

Medicine (Baltimore) 2018 Aug;97(34):e11913

Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Introduction: Capillary leak syndrome (CLS) is characterized by hypoproteinemia, diffused pitting edema, noncardiogenic pulmonary edema, and hypotension. By far, there are no related reports of CLS secondary to malignant hypertension (MHT). A 33-year-old male was admitted to our hospital with the diagnosis of CLS on the background of MHT. Read More

J Vet Emerg Crit Care (San Antonio) 2018 Sep 3;28(5):415-428. Epub 2018 Aug 3.

Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.

Objective: To assess distribution of alveolar-interstitial syndrome (AIS) detected by lung ultrasound (LUS) compared to thoracic radiographs (TXR).

Design: Prospective study.

Setting: University teaching hospital. Read More

Respir Med 2018 08 3;141:150-158. Epub 2018 Jul 3.

Pulmonary, Critical Care and Sleep Medicine, U C San Diego School of Medicine, USA. Electronic address:

Acute Respiratory Distress Syndrome (ARDS) is a condition of varied etiology characterized by the acute onset (within 1 week of the inciting event) of hypoxemia, reduced lung compliance, diffuse lung inflammation and bilateral opacities on chest imaging attributable to noncardiogenic (increased permeability) pulmonary edema. Although multi-organ failure is the most common cause of death in ARDS, an estimated 10-15% of the deaths in ARDS are caused due to refractory hypoxemia, i.e. Read More

Masui 2017 May;66(5):493-502

The evaluation of the lung has usually been considered off-limits for ultrasound, because ultrasound energy is rapidly dissipated by air. Lung ultrasound is not useful for the evaluation of the pulmonary parenchyma and the pleural line. However ultrasound machines have become more portable, with decreased start-up time, while simultaneously providing improved image quality and ease of image acquisition. Read More

Chest 2018 03 26;153(3):689-696. Epub 2017 Oct 26.

Department of Pulmonary and Critical Care Medicine, Long Island Jewish Medical Center, New Hyde Park, NY.

Background: The presence of B lines on lung ultrasonography is a characteristic feature of both cardiogenic pulmonary edema (CPE) and noncardiogenic alveolar interstitial syndrome (NCAIS), so their presence does not allow the clinician to differentiate between the two entities. Our study used M-mode ultrasonography of the pleura to differentiate CPE from NCAIS.

Methods: A total of 43 subjects were enrolled in the study, and based on history, physical examination, and chart review, the patients were divided into three groups: an NCAIS group, a CPE group, and a control group. Read More

Eur Respir Rev 2017 Jan 31;26(143). Epub 2017 Jan 31.

Dept of Internal Medicine, University Clinic Heidelberg, Heidelberg, Germany.

At any point 1-5 days following ascent to altitudes ≥2500 m, individuals are at risk of developing one of three forms of acute altitude illness: acute mountain sickness, a syndrome of nonspecific symptoms including headache, lassitude, dizziness and nausea; high-altitude cerebral oedema, a potentially fatal illness characterised by ataxia, decreased consciousness and characteristic changes on magnetic resonance imaging; and high-altitude pulmonary oedema, a noncardiogenic form of pulmonary oedema resulting from excessive hypoxic pulmonary vasoconstriction which can be fatal if not recognised and treated promptly. This review provides detailed information about each of these important clinical entities. After reviewing the clinical features, epidemiology and current understanding of the pathophysiology of each disorder, we describe the current pharmacological and nonpharmacological approaches to the prevention and treatment of these diseases. Read More

Vet Radiol Ultrasound 2017 May 22;58(3):259-265. Epub 2016 Dec 22.

Department of Clinical Sciences, National Veterinary School of Alfort, University of Paris-Est, 94700, Maisons-Alfort, France.

Noncardiogenic pulmonary edema is an important cause of respiratory disease in dogs and cats but few reports describe its radiographic appearance. The purpose of this retrospective case series study was to describe radiographic findings in a large cohort of dogs and cats with presumed noncardiogenic pulmonary edema and to test associations among radiographic findings versus cause of edema. Medical records were retrieved for dogs and cats with presumed noncardiogenic edema based on history, radiographic findings, and outcome. Read More

J Vet Emerg Crit Care (San Antonio) 2016 Nov 8;26(6):844-850. Epub 2016 Apr 8.

Department of Emergency and Critical Care, Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, 19104.

Objective: To describe a case of suspected drug-induced infiltrative lung disease (ILD) and acute respiratory failure associated with the administration of cytarabine and prednisone in a dog requiring mechanical ventilation.

Case Summary: A 4.5-year-old, female spayed Yorkshire Terrier presented to the ICU with acute onset of respiratory distress following a 24-hour cytarabine infusion. Read More

Mayo Clin Proc 2016 Mar 5;91(3):362-6. Epub 2016 Feb 5.

Department of Anesthesiology and Critical Care, Mayo Clinic, Rochester, MN; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Electronic address:

Nonanaphylactic noncardiogenic pulmonary edema leading to cardiorespiratory arrest related to the magnetic resonance imaging contrast agent gadobutrol has rarely been reported in the literature. Rarer is the association of hypokalemia with acidosis. We report 2 patients who had severe pulmonary edema associated with the use of gadobutrol contrast in the absence of other inciting agents or events. Read More

Echocardiography 2016 May 3;33(5):778-87. Epub 2016 Feb 3.

Cardiology Division, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina.

Pulmonary edema is a frequent condition found in adult patients hospitalized in cardiology wards and intensive care units. Ultrasonography is a diagnostic modality with a high sensitivity for the detection of extravascular lung water, visualized as B lines, and usually caused by cardiogenic or noncardiogenic pulmonary edema. This paper highlights a simple method for the assessment of patients with pulmonary edema, which allows for a differential diagnosis of its possible mechanism and contributes to therapeutic intervention guiding and monitoring. Read More

Pediatr Pulmonol 2016 Jul 19;51(7):E25-7. Epub 2016 Jan 19.

Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.

A 12-year-old boy developed severe acute respiratory distress during a school break requiring resuscitative measures. The episode started shortly after a short choking episode with a cookie. History, physical examination, laboratory results, chest X-ray, and clinical course supported the diagnosis of negative pressure pulmonary edema (NPPE). Read More

Eur Rev Med Pharmacol Sci 2012 Oct;16 Suppl 4:110-2

Department of Anesthesiology and Reanimation, Abant Izzet Baysal, University Medical School, Bolu, Turkey.

Gadobutrol is a contrast agent often used during magnetic resonance imaging (MRI). The agent has several side effects, some of which can be serious. It has extremely rare life-threatening systemic complications, which can lead to bronchospasm, hypersensitivity reactions and cardiovascular arrest. Read More

J Vet Emerg Crit Care (San Antonio) 2011 Oct 14;21(5):552-7. Epub 2011 Sep 14.

Angell Animal Medical Center, Emergency Critical Care Department, 350 South Huntington Ave., Jamaica Plain, MA 02130, USA.

Objective: To describe the medical management of pneumoperitoneum without surgical intervention in a dog that sustained blunt force trauma to the thorax. To review the mechanisms of how a thoracic injury (ie, extra-abdominal source) can lead to pneumoperitoneum.

Case Summary: A 4-month-old Shih Tzu puppy was attacked by a larger dog and sustained various injuries including a pneumothorax, pneumomediastinum, and a pneumoperitoneum. Read More

Am J Emerg Med 2012 Sep 25;30(7):1324.e1-4. Epub 2011 Aug 25.

Department of Emergency Medicine, Alameda County Medical Center Highland, Oakland, CA 94602, USA.

Bedside ultrasound is being increasingly used by emergency physicians (EPs) for the differentiation of acute dyspnea in critically ill patients. Lung ultrasound is emerging as a highly sensitive tool in diagnosing alveolar interstitial edema with the presence of diffuse “B-lines” arising from the pleural line. However, when used independently, lung ultrasound is unable to differentiate between cardiogenic and noncardiogenic causes of pulmonary edema. Read More

J Magn Reson Imaging 2011 Nov 18;34(5):1092-8. Epub 2011 Aug 18.

Biomedical MR Science Center, Shiga University of Medical Science, Shiga, Japan.

Purpose: To apply magnetic resonance (MR) imaging to differential diagnosis of cardiogenic pulmonary edema (CPE) and noncardiogenic pulmonary edema (NCPE).

Materials And Methods: In the CPE group, MR measurements were performed on 5 rats just before and 3 h after administration of 21 ± 2% body weight of normal saline. In the NCPE group, measurements were similarly performed on 5 animals just before and 48 h after 0. Read More

Ann Pharmacother 2011 Jul 13;45(7-8):e42. Epub 2011 Jun 13.

Bridgeport Hospital and Yale University School of Medicine, Bridgeport, CT, USA.

Objective: To report a case of fulminant shock and noncardiogenic pulmonary edema induced by intravenously administered dipyridamole.

Case Summary: A 73-year-old woman presented to the office of her cardiologist for dipyridamole myocardial scintigraphy. Several minutes after administration of intravenous dipyridamole 0. Read More

Radiol Med 2011 Mar 3;116(2):246-63. Epub 2010 Dec 3.

Area di Radiologia, IRST-Istituto Romagnolo Studio e cura dei Tumori, Meldola, Forlì, Italy.

Purpose: This study compared the results of high-resolution computed tomography (HRCT) and cytohistology after transbronchial biopsy in the evaluation of drug-related interstitial lung disease (DR-ILD).

Materials And Methods: Patients with a clinical and imaging diagnosis of DR-ILD were prospectively included in a study protocol lasting 5 years. All patients were evaluated by bronchoscopy with transbronchial biopsy or bronchoalveolar lavage (BAL) following an HRCT examination that raised a suspicion of DR-ILD. Read More

J Cardiothorac Vasc Anesth 2012 Feb 24;26(1):178-9. Epub 2010 Nov 24.

Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.

Mil Med 2010 Mar;175(3):iii-iv

Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA.

J Cardiothorac Vasc Anesth 2010 Aug 8;24(4):681-90. Epub 2010 Jan 8.

The Mount Sinai School of Medicine, New York, NY, USA.

In this review, the authors discussed criteria for diagnosing ALI; incidence, etiology, preoperative risk factors, intraoperative management, risk-reduction strategies, treatment, and prognosis. The anesthesiologist needs to maintain an index of suspicion for ALI in the perioperative period of thoracic surgery, particularly after lung resection on the right side. Acute hypoxemia, imaging analysis for diffuse infiltrates, and detecting a noncardiogenic origin for pulmonary edema are important hallmarks of acute lung injury. Read More

J Spec Oper Med 2009 ;9(3):44-50

Swimming induced pulmonary edema (SIPE) is associated with both SCUBA diving and strenuous surface swimming; however, the majority of reported cases and clinically observed cases tend to occur during or after aggressive surface swimming. Capillary stress failure appears to be central to the pathophysiology of this disorder. Regional pulmonary capillaries are exposed to relatively high pressures secondary to increased vascular volume, elevation of pulmonary vascular resistance, and regional differences in perfusion secondary to forces of gravity and high cardiac output. Read More

Am J Emerg Med 2008 Feb;26(2):250.e1-5

Service d'Anesthésie-réanimation Centrale, CHU Ibn Rochd Casablanca Morocco 20200.

Accidental intra-arterial injection is a potentially devastating complication of the intragluteal injection of benzathine penicillin. A 35-year-old woman developed after intramuscular injection of benzathine penicillin G acute paraplegia and noncardiogenic pulmonary edema. Noninvasive positive pressure ventilation was initiated with furosemide and corticosteroids. Read More