How should a patient presenting with acute pulmonary edema be evaluated to establish the cause and determine appropriate therapy?
This article reviews the evaluation and management of acute pulmonary edema based on a clinical vignette.
A 62-year-old man presents with a three-day history of progressive dyspnea, nonproductive cough, and low-grade fever. His blood pressure is 100/60 mm Hg, his heart rate 110 beats per minute, his temperature 37.9°C, and his oxygen saturation while breathing room air 86 percent. Chest auscultation reveals rales and rhonchi bilaterally. A chest radiograph shows bilateral pulmonary infiltrates consistent with pulmonary edema and borderline enlargement of the cardiac silhouette. How should this patient be evaluated to establish the cause of the acute pulmonary edema and to determine appropriate therapy?
Ware et al. (2005) studied this question.