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(Circulation. 2002;105:899.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Flash Pulmonary Edema Heralding Renal Artery Stenosis

Shehzad Basaria, MD; Herbert L. Fred, MD

From the Department of Internal Medicine, The University of Texas Health Science Center at Houston, Tex.

Correspondence to Dr Herbert L. Fred, 8181 Fannin, Suite 316, Houston, TX77054.

A 41-year-old woman was referred for evaluation of long-standing, poorly controlled systemic hypertension. Her medical records disclosed that she had suffered numerous bouts of pulmonary edema that always came on abruptly and resolved rapidly. Between these bouts, she was asymptomatic, and her only physical abnormality was the persistently elevated blood pressure. Her interim chest radiographs, echocardiograms, urinalyses, and serum creatinine concentrations were normal.

These findings were diagnostic of so-called "flash" pulmonary edema, a potentially reversible condition frequently associated with occlusive disease of the renal arteries (usually both). We, therefore, obtained a magnetic resonance angiogram that showed bilateral renal artery stenosis (Figure 1). After angioplasty of the affected arteries and placement of stents therein (Figure 2), her blood pressure normalized. She has remained free of pulmonary edema for 3 years.

View larger version (176K): [in this window] [in a new window]   Figure 1. Magnetic resonance angiogram showing bilateral renal artery stenosis (arrows).

View larger version (137K): [in this window] [in a new window]   Figure 2. Digital subtraction angiogram showing renal arteries after angioplasty with stents in place (arrows).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St.Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editoral Office, St.Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Houston, TX 77030.

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