Physical examination
Pulmonary edema requires prompt treatment, you'll initially be diagnosed
on the basis of your symptoms and a physical exam, electrocardiogram and chest
X-ray.
Doctor will listen to your lungs and heart with a stethoscope to check
for:
- Abnormal heart sounds
- Crackles in your lungs, called rales
- Increased heart rate (tachycardia)
- Rapid breathing (tachypnea)
- Other things that may be seen during the exam include:
- Leg or abdominal swelling
- Abnormalities of your neck veins (which can show that there is too much fluid in your body)
- Pale or blue skin color (pallor or cyanosis)
Tests that may be done to diagnose pulmonary edema or to determine why
you developed fluid in your lungs include:
Chest X-ray
Pulmonary edema is typically diagnosed by a chest X-ray. A normal chest
radiograph (X-ray) consists of a central white area pertaining to the heart and
its main blood vessels plus the bones of the vertebral column, with the lung
fields showing as darker fields on either side, enclosed by the bony structures
of the chest wall.
A typical chest X-ray with pulmonary edema may show a more white
appearance over both lung fields than usual. More severe cases of pulmonary
edema can demonstrate significant opacification (whitening) over the lungs with
minimal visualization of the normal lung fields. This whitening represents
filling of the alveoli as a result of pulmonary edema, but it may give minimal
information about the possible underlying cause.
To identify the cause of pulmonary edema, a thorough assessment of the
patient's clinical picture is essential. A careful medical history and physical
examination often provide invaluable information regarding the cause. Pulse oximetry. In pulse oximetry, a sensor attached to your finger or
ear uses light to determine how much oxygen is in your blood.
Blood tests.
You may have blood drawn, usually from an artery in your wrist, so that
it can be checked for the amount of oxygen and carbon dioxide it contains (arterial
blood gas concentrations).
Your blood may also be checked for levels of a substance called B-type
natriuretic peptide (BNP). Increased levels of BNP may indicate that your
pulmonary edema is caused by a heart condition.
Other blood tests may be done — including tests of your kidney function,
thyroid function and blood count — as well as tests to exclude a heart attack
as the cause of your pulmonary edema.
Electrocardiogram (ECG).
This noninvasive test can reveal a wide range of information about your
heart. During an ECG, patches attached to your skin receive electrical impulses
from your heart. These are recorded in the form of waves on graph paper or a
monitor. The wave patterns show your heart rate and rhythm and whether areas of
your heart show diminished blood flow.
Echocardiogram.
An echocardiogram is a noninvasive test that uses a wand-shaped device
called a transducer to generate high-frequency sound waves that are reflected
from the tissues of your heart. The sound waves are then sent to a machine that
uses them to compose images of your heart on a monitor.
Transesophageal echocardiography (TEE).
In a traditional cardiac ultrasound exam, the transducer remains outside
your body on the chest wall. But in TEE, a doctor inserts a soft, flexible tube
(catheter) with a transducer attached to the tip through your mouth and guides
it into your esophagus — the passage leading to your stomach.
Pulmonary artery catheterization.
If other tests don't reveal the reason for your pulmonary edema, your
doctor may suggest a procedure to measure the pressure in your lung capillaries
(wedge pressure).
Cardiac catheterization.
If tests such as an ECG or echocardiography don't uncover the cause of
your pulmonary edema, or you also have chest pain, your doctor may suggest
cardiac catheterization and coronary angiogram.
