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Pathophysiology of Postpneumonectomy Pulmonary Edema

Department of Anesthesiology, Mayo Clinic and Mayo Foundation, Rochester, MN

Pulmonary edema is a rare, potentially fatal complica tion associated with major resection of the lung, usually pneumonectomy. Although pulmonary edema in this setting can often be attributed to a variety of causes such as cardiac failure, bacterial pneumonia, and fluid overload, the specific syndrome of postpneumonec tomy pulmonary edema (PPE) occurs in the absence of these factors. PPE remains a diagnosis of exclusion, and its pathophysiology is poorly understood. Overzealous perioperative fluid administration has traditionally been implicated in clinical cases of postpneumonectomy pulmonary edema, but there is a body of evidence suggesting several other potential mechanisms. These include increases in cardiac output secondary to cat echolamine release, interruption of mediastinal lym phatic drainage, endothelial injury secondary to release of humoral factors or stretching of intercellular junc tions, hyperinflation, and other unknown factors.

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