Cuando sospechar de edema fugaz pulmonar / When suspect pulmonary oedema flash

Edema pulmonar relámpago o edema pulmonar fugaz es una condición clínica caracterizada por episodios recurrentes y súdbitos de disnea en reposo, resultado en congestión pulmonar venosa aguda pero en la presencia de función sistólica del ventrículo izquierdo normal o preservada. Está usualmente asociada a estenosis bilateral o unilateral de la arteria renal en riñón único. Relatamos un caso de una paciente femenina de 60 años de edad, con enfermedad arterial coronaria, que desarrolló estenosis de arteria renal unilateral derecha y presentó un episodio de edema fugaz pulmonar. El tratamiento consistió en intervención percutánea en la arteria renal derecha con la colocación de prótesis metálica o stent.

Flash pulmonary edema is a condition characterizaed by sudden and recurrent episodes of dyspnea at rest resulting from acute pulmonary venous congestion in the presence of normal or well-preserved LV systolic function. This is usually associated with bilateral renal artery stenosis of a single surviving kidney. We report a case of a 60-year-old woman, with coronary artery disease who later developed unilateral renal artery atenosis and presented with one episode of flash pulmonary edema. She was successfully treated with stenting of the compromised renal artery.

A Medically Treated Case of Renal Artery Stenosis Presented with `Flash Pulmonary Edema' / 대한신장학회잡지

Renal artery stenosis is a rare cause of acute pulmonary edema. So-called flash pulmonary edema is associated with bilateral renal artery stenosis or stenosis in a single functioning kidney. Most patients have co-morbid cardiovascular disease and a renovascular etiology is overlooked. Flash pulmonary edema has been recognized as an absolute indication for vascular intervention. However, our case could be treated with medical treatment directing a complete inhibition of renin-angiotensin system. A 81- year old man was admitted with acute shortness of breath. During that admission, despite the dialysis therapy for renal insufficiency, he had four severe episodes of acute pulmonary edema requiring mechanical ventilation. CT angiography showed bilateral renal artery stenosis. After administration of ACE inhibitor, angiotensin receptor blocker, and spironolactone, there was no further attack of pulmonary edema.

Bilateral Renal Artery Stenosis with Renal Insufficiency: Successful Angioplasty Using Gadopentetate Dimeglumine as a Contrast Agent / 대한신장학회잡지

With the increasing number of interventional angiographic procedures, iodinated contrast induced nephropathy has become an important cause of iatrogenic acute renal failure. Gadopentetate dimeglumine, gadolinium chelated by DTPA, are widely used in magnetic resonance imaging without adverse effect on renal function in patients with renal insufficiency. It also has sufficient radiographic density to allow visualization and has been described as an alternative contrast agent for angiography. Here we report a case of successful angioplasty using gadopentetate dimeglumine as a contrast agent in a patient with both renal artery stenosis and renal insufficiency. The patient had a history of iodinated contrast induced acute renal failure. Using this contrast agent, angioplasty was successfully performed and contrast induced acute renal failure did not occur after this procedure.