Clinics in chest medicine
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Neurogenic pulmonary edema is an anomaly because it cannot be categorized into either of the two major types of pulmonary edema. Both high-pressure and increased-permeability abnormalities may be involved in the pathogenesis of neurogenic pulmonary edema. Furthermore, the mechanisms responsible for these abnormalities appear quite complex. ⋯ Although the high-pressure and increased-permeability abnormalities seem to develop through separate mechanisms, their combined effect is probably synergistic on the accumulation of extravascular lung water. The neurologic pathways responsible for initiating neurogenic pulmonary edema remains a mystery. Despite the questions and uncertainties still surrounding neurogenic pulmonary edema, the substantial progress made in understanding the clinical expression, incidence, and pathogenesis of this syndrome does provide a framework for a reasonable approach to its clinical management.
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Pleural effusions are a common clinical problem, yet the mechanisms of pleural fluid formation have only recently been investigated. In this article, the anatomy and physiology of the normal pleural space is discussed, as well as the pathophysiology of pleural effusion formation.
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Clinics in chest medicine · Sep 1985
ReviewUltrastructural abnormalities in increased-permeability pulmonary edema.
A general clinical impression is that increased microvascular permeability following acute lung injury always leads to pulmonary edema. The ARDS is a final pathway of acute lung injury. A number of agents may initiate acute lung injury, either directly or indirectly, via cellular and humoral mediators. ⋯ Thus pathologic examination often reveals little about the exact underlying etiology of the lung injury. This situation has minimized the diagnostic value of lung biopsies in clinical cases of increased-permeability pulmonary edema. Nonetheless, the pathologic information has been, and will continue to be, invaluable to understanding the structural and functional relationships present in experimental models of increased-permeability pulmonary edema.
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Pulmonary edema can cause alterations in lung mechanics that directly contribute to clinical morbidity and mortality rates. Both the location of the edema fluid (interstitital versus alveolar pulmonary edema) and the etiology of the pulmonary edema contribute to the severity and type of abnormalities of lung mechanics observed. The alterations in lung mechanics associated with the adult respiratory distress syndrome may involve the direct effects of released mediators, alterations in pulmonary surfactant, and altered airway reactivity, as well as the direct effects of the edema fluid.