B B Forster, N L Müller, J R Mayo, M Okazawa, B J Wiggs and P D Paré experimental hydrostatic pulmonary edema. High-resolution computed tomography of.
High-resolution computed tomography of experimental hydrostatic pulmonary edema. B B Forster, N L Müller, J R Mayo, M Okazawa, B J Wiggs and P D Paré Chest 1992;101;1434-1437 DOI 10.1378/chest.101.5.1434 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/101/5/1434
Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1992by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692
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L i]
laboratory and animal investigations
-
High-Resolution
Computed
Experimental Bruce
Hydrostatic
B. h)r.s’tcr,
Jo/ii
R.
Mayo,
Barr,jJ.
R.
M.D.;
Ne.s’tor
M.D.;
Wiggs,
M.Sc.;
Pulmonary
L.
Muller,
Okaxawa,
Mitsu.s’Iii and
Peter
D.
To better understand the distribution and clearance mechanisms of extravascular lung water (EVLW) in pulmonary edema, computed tomographic (CT) scans ofisolated canine lungs were obtained. In this model, there is no active lymphatic drainage. Fourteen isolated lobes were inflated with oxygen, and edema was induced by infusion of normal saline solution. Two volumes ofsaline were used, 50 percent and 150 percent of initial wet lobar weight. Six 10-mmand 1.5-mm-collimation CT scans were obtained at 10-mm intervals
from
the
and after
each
CT
were
scans
ologists subjective
P
reviewed
ulnionarv
occurs
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hen
The
standard
reprOdthcibilit\
graphs increased
heart
failure
eclenla
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and
first
is
“cuff” to
of fluid.3 the
involve
conclusively alveolar
that
clue
i1(
level.
Niore
bronchovascular
there receIltl
111
it
tenstitial
are
to
in
the
the
Department
.I1\()) LI1(l tlit \Vigjs, t,ic1 Pare), (anaLda. SI))Ot((l
1434
l)\
d
of LTniersitv
Radn)log\
(Drs
Research t.aboratorv of British (ol,iiihia,
the
f,o,i,
the (2LILdiL,i
hyatt
is
pill-
we
used qual-
CT
inages
to both
the
(listnii)tltion
using
au
lymphatic
no
lobe
clearance,
we
niechanisms
cuffing
so
seen
in clinical
edenia
of
isolated
clearance
penibnonchial
1)t1I1iih1any’
toino-
clinical
ailalyze
the
the
for
or
by
there
. First,
performed,’
understand
practice.
this
has
it
tour
at the
sodii,ni
istvre(l
I tT/’kg),
(2(1(X)
dl)(l
sas
pen-
,irv
been
at
Nililler,
aal
0ka.zava, \tiuontr,
Fo,,,idatio,,.
in
bruticlus
and
i1fl,sed
at
(‘()IlsttIIt
(6.4
50 to
‘I’he
22.5
High-Resolution
with
intraseianis
vas L(lnun-
he1,ri,, killed
lobes
lobes
liv exsanguination.
cannl,lat(’(l;
vt’re
thei
ld
been
period of
30 cm
150
Ixrcent
d,1(l
19.2
to
CT of Experimental
obtained via
and
i,iflatxl 6 or
of
,
the
I 10.
Two
67.5
(Lild
ol,,nes control
trter
the
Pulmonary
lohar MlI1u)-
111ai1tdi1e(l
solution catheter
of saline \v(’t
lol)ar
ere veight
Since
respectivel).
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the
15 c’ni I 120. nornal saline
pt,lnonar
of the
Hydrostatic
and
14 lobes
of
weighed;
were
vere
pr(’ssItre
a 5-n,in
pressure I)rC’’Iit
The
artery
(T inages
over
were
dI)iIlULl5
stlI(l#{188}
.
anesthetized I ntravelu)IIs
aiI divi(le(l into lobes; a li)tal
pIlIIB)narV
control
\#{149}(Ls i
dIKI tl
tlit
ligate(l
svere
,ag/kg).
tnLnsMlflu)flarV
(‘OIlst.ttIt
d
1) ME’nIIoDs
AN
(logs (30
)(‘IllOV(’d
i,(llI(l(’(l
were
li;we (Drs
,aongrel
d(hIlt
Tl lungs v’re
been
.s
((/
pvltol)arl)ital
1,s((l, gra,it
been
Second,
which i)etten
twofold
experimental
high-nesolutioii
!‘Xp(’rl?IUfltal
a for
alveolar
l’orster,
was
conllM,ted
quantitatively
in
After *Frfl
)
for
is over-
occurs.
of
in eclenia.
t(
pathways
high-resolution
NI,’rEh11.x1
producing
no lyniphatics
conipartments
at the
compantnient
is investigation
have
and
coniinonlv
is traditionally
Yet
filling
fe’
aiul
)l)e(l
clearance
studies
alveolar
pathway
lvnlphatics.
that
ShOWI1
The
although
airways
water
interstitial
th
of
edema
model
respi-
centrally ,
and
is generally
in the
space
vessels
important
this
(CT)
EVL\V
(contilt
(ad
It
cleared
tincleat
iS
very
itativelv
plhlnlonar}
accumulates
interstitial
nioveinent
l)eCatlSe
standard
radio-
fron3
hydrostatic
rapidly
peribronclloascLhIar
peribrncllial
pt nl)5e
fllOIliui’V
tI5(,
secondary
ity
understood.
EVL\V
but
thought
fitiltire)
blood
lung
alveolar
,
The
responsil)le of’
inconpletelv tikit
vhelmed
graphic
of
chest
as \Vhen
EVL’sV.’ of
pressure
permeat)il
the
extravascular
=
iniplicated
oveireference
edenla
renal
in-
svndronie).
iiiterstitium
fluid
plain
of’
EVLV
which
ease
COst,
around
hilum. This gradient may play a major role in the characteristic perihilar and peribronchial distribution of EVLW seen radiologically in patients with hydrostatic pulmonary edema. (Chest 1992; 101:1434-37)
quantitation
hydrostatic
pathophvsiology
tccepte(l
lOW
P/iD.;
M.D.
are the and
(lifferentiate
m icrovascular
distress
The
to
fli icrovascular
increased
ratorv
assessnient of
Pare,
interstitium
The
clearance
t,ltrafiltiate remains
FCC.?,
,
chest
(EVL\V), of
Edema*
inantly central peribronchial distribution of EVLW in the isolated lungs. Airway wall thickness also increased from the control value (average thickness, 1 .0 mm) to 150 percent edema (average thickness, 1.5 mm)(p
