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) #Noncardiogenic #pulmonary #edema #NCPE #differential #diagnosis #cardiology
