<B>Pulmonary Vascular Congestion </B>

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Pulmonary Vascular Congestion

Etiology:

• Generally associated with left-sided heart failure
• Etiology of heart failure includes myocardial damage associated with valvular, coronary arterial, or intrinsic myocardial injury
• Other causes include blood loss, peripheral vasodilatation (shock)

Pathogenesis:

• Increased left atrial pressure leads to increased pulmonary venous pressure to increased pulmonary capillary pressure with congestion and ultimately transudation (edema)

Epidemiology:

• Ischemic cardiac disease is leading cause of death in U.S.
• Variety of disease processes result in left sided failure.

General Gross Description:

• Heavy wet lungs
• Deep red
• Ooze bloody fluid on sectioning
• When chronic, rusty discoloration may occur

General Microscopic Description:

• Dilated blood vessels containing abundant RBC's
• Scattered RBC's may be found in the alveoli due to diapedesis which lead to
• Hemosiderin-laden macrophages (heart failure cells) appearing with a few days
• Protein-rich edema fluid may also be present

Clinical Correlations:

• Dyspnea first on exertion, then lying down (orthopnea) and then at rest

References:
• Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of Disease. 5th edition. W.B. Saunders. 1994.