Noncardiogenic Pulmonary Edema - Differential Diagnosis Framework



NCPE Pathophysiology:

Noncardiogenic pulmonary edema occurs because of excessive pulmonary capillary permeability.  Causes include:

1. Excessive renin-angiotensin-aldosterone system activity,

2. Impaired nitric oxide synthesis,

3. Increased endothelin levels,

4. Excessive circulating catecholamines.



History/Physical/Labs:

 • A lack of acute cardiac disease

 • Normal or negative fluid balance

 • Flat neck veins,

 • Absence of peripheral edema

 • BNP level <100 pg/ml

EKG:

 • Negative for ischemic changes

CXR:

 • Pulmonary vascular congestion:

 • Patchy or peripheral distribution

 • Heart size: Normal

ECHO:

 • Normal or small chamber size

 • Normal left ventricular function

Pulmonary-Artery Catheterization:

 • PCWP < 18 mmHg



Etiology:

 • Acute respiratory distress syndrome (ARDS)

 • Opioid overdose

 • Naloxone use causing non-cardiogenic pulmonary edema

 • High altitude pulmonary edema

 • Bowel infarction

 • Gram negative sepsis

 • Salicylate toxicity

 • Pulmonary embolism

 • Re-expansion pulmonary edema (unilateral pulmonary edema)

 • Reperfusion pulmonary edema (unilateral pulmonary edema)

 • Transfusion-related acute lung injury (TRALI)

 • Aspiration of gastric contents

 • Head injury

 • Pulmonary HTN

 • Airway obstruction (laryngospasm)

 • Preeclampsia/eclampsia

 • Neurogenic pulmonary edema (Traumatic brain injury, cerebral hemorrhage, seizure activity, especially status epilepticus)



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