Flash Pulmonary Edema Heralding Renal Artery Stenosis
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.
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.
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