Pulmonary edema physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Farnaz Khalighinejad, MD [2]

## Overview

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Patients with pulmonary edema usually appear agitated. Physical examination of patients with pulmonary edema is usually remarkable for dyspnea, tachypnea. The presence of abnormal cardiac examination on physical examination is diagnostic of cardiogenic pulmonary edema. Patients with noncardiogenic pulmonary edema may have warm extremities, whereas patients with cardiogenic pulmonary edema may have cool extremities.

## Physical Examination

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Physical examination of patients with pulmonary edema is usually remarkable for:[1][2]

* Dyspnea

* Tachypnea

Differentiation of cardiogenic pulmonary edema and noncardiogenic pulmonary edema Clinical examination

Cardiogenic pulmonary edema  | Low flow state=cool periphery | S3 gallop/cardiomegaly | Jugular venous distention | Crackles(wet)
Noncardiogenic pulmonary edema  | High flow state=warm periphery | No gallop | No jugular venous distention | Crackles(dry) |

### Appearance of the Patient

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* Patients with pulmonary edema usually appear:
* Anxious
* Decrease in level of alertness (consciousness)
* Inability to speak in full sentences

### Vital Signs

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* Hyperthermia may be present
* Tachycardia with regular pulse
* Tachypnea
* High/low blood pressure with normal pulse pressure

### Skin

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* Pallor
* Cold and clammy in cardiogenic pulmonary edema
* Warm extremities in noncardiogenic pulmonary edema
* livedo reticularis
* Peripheral cyanosis may be present

### HEENT

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* Nasal flaring
* Dilated alae nasi

### Neck

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* Neck examination of patients with pulmonary edema is usually normal

### Lungs

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* Wheezing may be present
* Prolonged expiratory phase
* Retraction of intercostal muscle
* Use of accessory muscles of respiration

### Heart

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* A third heart sound (S3) may be present
* Pulsus alternans
* Alternating weak and strong pulse, may be a sign of left ventricular failure in CHF as underlying cause of cardiogenic pulmonary edema
* Heart sounds with presence of S3, S4, and harsh murmur
* JVD

### Abdomen

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* Abdomen examination of patients with pulmonary edema is usually normal

### Back

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* Back examination of patients with pulmonary edema is usually normal

### Genitourinary

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* Genitourinary examination of patients with pulmonary edema is usually normal

### Neuromuscular

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* Neurologic examination may reveal focal signs as neurogenic causes of pulmonary edema

### Extremities

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* Peripheral edema of extremities

## References

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1. ↑ Ware LB, Matthay MA (December 2005). "Clinical practice. Acute pulmonary edema". N. Engl. J. Med. 353 (26): 2788–96. doi:10.1056/NEJMcp052699. PMID 16382065.
2. ↑ Sibbald WJ, Cunningham DR, Chin DN (October 1983). "Non-cardiac or cardiac pulmonary edema? A practical approach to clinical differentiation in critically ill patients". Chest. 84 (4): 452–61. PMID 6617283.

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