Pulmonary edema physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Overview

Patients with pulmonary edema usually appear agitated. Physical examination of patients with pulmonary edema is usually remarkable for dyspnea, tachypnea. The presence of abnormal cardiac examination on physical examination is diagnostic of cardiogenic pulmonary edema. Patients with noncardiogenic pulmonary edema may have warm extremities, whereas patients with cardiogenic pulmonary edema may have cool extremities.

Physical Examination

Physical examination of patients with pulmonary edema is usually remarkable for:^[1]^[2]

Dyspnea

Tachypnea

**Differentiation of cardiogenic pulmonary edema and noncardiogenic pulmonary edema**
Clinical examination
Cardiogenic pulmonary edema	Low flow state=cool periphery	S3 gallop/cardiomegaly	Jugular venous distention	Crackles(wet)
Noncardiogenic pulmonary edema	High flow state=warm periphery	No gallop	No jugular venous distention	Crackles(dry)

Appearance of the Patient

Patients with pulmonary edema usually appear:
- Anxious
- Decrease in level of alertness (consciousness)
- Inability to speak in full sentences

Vital Signs

Hyperthermia may be present
Tachycardia with regular pulse
Tachypnea
High/low blood pressure with normal pulse pressure

Skin

Pallor
Cold and clammy in cardiogenic pulmonary edema
Warm extremities in noncardiogenic pulmonary edema
livedo reticularis
Peripheral cyanosis may be present

HEENT

Nasal flaring
Dilated alae nasi

Neck

Neck examination of patients with pulmonary edema is usually normal

Lungs

Wheezing may be present
Prolonged expiratory phase
Retraction of intercostal muscle
Use of accessory muscles of respiration

Heart

A third heart sound (S3) may be present
Pulsus alternans
Alternating weak and strong pulse, may be a sign of left ventricular failure in CHF as underlying cause of cardiogenic pulmonary edema
Heart sounds with presence of S3, S4, and harsh murmur
JVD

Abdomen

Abdomen examination of patients with pulmonary edema is usually normal

Back

Back examination of patients with pulmonary edema is usually normal

Genitourinary

Genitourinary examination of patients with pulmonary edema is usually normal

Neuromuscular

Neurologic examination may reveal focal signs as neurogenic causes of pulmonary edema

Extremities

Peripheral edema of extremities

References

↑ Ware LB, Matthay MA (December 2005). “Clinical practice. Acute pulmonary edema”. N. Engl. J. Med. 353 (26): 2788–96. doi:10.1056/NEJMcp052699. PMID 16382065.
↑ Sibbald WJ, Cunningham DR, Chin DN (October 1983). “Non-cardiac or cardiac pulmonary edema? A practical approach to clinical differentiation in critically ill patients”. Chest. 84 (4): 452–61. PMID 6617283.

Template:WikiDoc Sources

[pmid16382065-1] Ware LB, Matthay MA (December 2005). “Clinical practice. Acute pulmonary edema”. N. Engl. J. Med. 353 (26): 2788–96. doi:10.1056/NEJMcp052699. PMID 16382065.

[pmid6617283-2] Sibbald WJ, Cunningham DR, Chin DN (October 1983). “Non-cardiac or cardiac pulmonary edema? A practical approach to clinical differentiation in critically ill patients”. Chest. 84 (4): 452–61. PMID 6617283.

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