Diagnosis

The basic diagnosis in suspected pulmonary edema includes a clinical examination. This includes on the one hand auscultation of the lung, i.e. listening with a stethoscope. If there is fluid in the pulmonary alveoli, a so-called damp rales can be heard when breathing.

Interstitial pulmonary edema is often not audible. In addition, during percussion, i.e. tapping the lungs, it is noticeable that the tapping sound is muffled by the accumulation of fluid. A healthy lung is filled with air, and in this case the tapping sound sounds somewhat hollow. In addition, the pulmonary edema is made visible by means of diagnostic imaging, which involves the use of X-rays.

What can you see in the X-ray image?

In the x-ray of the thorax it can be recognized by typical signs. These include: milky glass shading, i.e. a diffuse, blotchy drawing of the lung tissue, perihilar shading, i.e. whitish drawings around the area of the lung where the vessels enter and exit, and the so-called “Kerley B-lines”, horizontal lines in the lung tissue.

Overall, the pulmonary edema thus appears as diffuse white patches in the X-ray image.

The frosted glass shading, i.e. a diffuse, blotchy drawing of the lung tissue,
Perihilar shadows, i.e. whitish drawings around the area of the lung where the vessels enter and exit,
As well as the so-called “Kerley B lines”, horizontal lines in the lung tissue.

These stadiums exist

The course of a pulmonary edema is divided into four stages. As has just been explained, if not treated, pulmonary edema can turn into a life-threatening emergency. For this reason, rapid diagnosis and immediate initiation of therapeutic measures are essential.

Stage 1: Initially, an “interstitial pulmonary edema” develops, which means that the water does not accumulate in the alveoli but within the lung tissue.
Stage 2: In the second stage, the “alveolar pulmonary edema”, the water also reaches the hollow space of the lung, i.e. the alveoli.
Stage 3: In the third stage, so much fluid has already accumulated in the alveoli that it reaches the airways, the bronchi. There a whitish foam is formed which can escape via the mouth when coughing.
Stage 4: The last, most serious stage is the life-threatening complication of pulmonary edema, known as “asphyxia”. Asphyxia is the total respiratory and circulatory arrest caused by insufficient oxygen supply.