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Annette Esper, MD, MSc, Greg S Martin, MD, MSc, FACP, and Gerald W Staton Jr, MD, FACP, have no relevant financial relationships to disclose.

Acknowledgments: Figure 3 Christine Kenney; Figures 1 and 2 Courtesy of Eugene Berkowitz, MD



  • Pulmonary Edema

Pulmonary Edema I: Cardiogenic Pulmonary Edema


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Among his many other prescient observations, in 1821, René Laennec described the appearance of edema in postmortem lung specimens.1 Using only his natural senses, he concluded that there were two pathophysiologically distinct forms of lung edema. One form was associated with pathology of the heart and, he concluded, was due to heart failure. The other form appeared in the absence of cardiac pathology, and Laennec called it “primary or idiopathic” pulmonary edema. Those observations were probably the first descriptions of the gross pathologic characteristics of hydrostatic pulmonary edema and permeability pulmonary edema—the latter being the clinical syndrome identified more than a century later as acute respiratory distress syndrome (ARDS). Laennec’s seminal contributions to the understanding of pulmonary edema were limited to gross pathologic observations, whereas greater understanding required technical advancements to study lung structure and function and keen interest from expert physiologists in the movement of fluid and solutes among anatomic compartments.

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