Monday, 25 November 2013

Pulmonary vascular disease: Pulmonary edema – The Misdiagnosis

Pulmonary vascular disease is defined as a condition of blood flow to the lung’s artery is blocked suddenly due to a blood clot somewhere in the body, including pulmonary embolism, chronic thromboembolic disease, pulmonary arterial hypertension, pulmonary veno-occlusive disease, pulmonary arteriovenous malformations, pulmonary edema, etc.
Pulmonary edema
Pulmonary edema is defined as a condition of fluid accumulation in the air spaces and parenchyma of the lungs of that can lead to difficult of breathing and respiratory failure.
A. Misdiagnosis
1. Pneumonia
Unilateral pulmonary edema can mimic as pneumonia. Clinician should be aware of differential diagnosis of pulmonary edema, otherwise it can lead to unnecessary investigation and delay in starting definitive treatment< according to the study by ths National University Hospital, National University Health System(20).
2. Acute rheumatic fever
Although the diagnostic criteria for acute rheumatic fever (ARF) are well known, a high index of suspicion is necessary in order to assure timely diagnosis and appropriate treatment. We present a case of an 8-year-old child who presented with unilateral pulmonary edema secondary to acute mitral insufficiency due to ARF. ARF should be considered in the differential diagnosis of unilateral pulmonary edema in children(21).
3. Acute mitral regurgitation
Differential diagnosis of unilateral alveolar pulmonary infiltration includes various possibilities. Acutely developing mitral insufficiency, often without any prior cardiac symptoms, may be the cause of pulmonary edema localized exclusively in the right upper lobe(22).
4. Amiodarone pneumonitis
There is a report of a case of the case of a 78-year-old woman with a history of cardiac surgery, who after 2 years of amiodarone therapy for prophylactic treatment of atrial fibrillation developed amiodarone pneumonitis mimicking an acute pulmonary edema(23).
5. Acute myocardial infarction
There is a report of a case of neurogenic pulmonary oedema (NPO) following massive left cerebral infarct, which was initially misdiagnosed as acute myocardial infarction (AMI)(24).

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