0
ARTICLE |

Albumin Lung/Heart Ratio Change: Title and subTitle BreakA Simple Clinical Means of Documenting Increased Pulmonary Endothelial Permeability to Protein FREE

Fred S. Mishkin, MD; Albert Niden, MD; Ashok Kumar, MD; Alvin Thomas, MD; Isaac C. Reese, PhD; Panukorn Vasinrapee, MD
[+] Author Affiliations

Read in part before the Western Society of the American Federation for Clinical Research, Carmel, Calif, Feb 10,1984, and the Western Regional Society of Nuclear Medicine Meeting, Monterey, Calif, Oct 12, 1984.

Reprint requests to Nuclear Medicine, Memorial Medical Center of Long Beach, 2801 Atlantic Ave, Long Beach, CA 90801 (Dr Mishkin).


JAMA. 1987;257(7):953-956. doi:10.1001/jama.1987.03390070073026
Text Size: A A A
Published online

We investigated a simple method that can be used at the bedside for documenting the net accumulation of albumin in the lung. The technique employs measurement with a computer-linked gamma camera of the activity ratio in an area of the right lung compared with the same-sized area in the heart at 20 minutes and three hours following intravenous injection of technetium Tc 99m albumin. We applied this measurement to three groups of patients: a control group and patients with roentgenographic evidence of edema classified according to clinically available criteria as either hydrostatic edema or permeability edema to see if we could document differences among these groups. In control patients this ratio did not increase by more than seven units between the 20-minute and three-hour measurements. Of 18 patients classified by other routine clinical means as having hydrostatic pulmonary edema, 89% showed no increase in lung albumin accumulation. In 29 patients with permeability edema associated with the so-called adult respiratory distress syndrome, 31% showed evidence of net pulmonary albumin accumulation. These findings suggest that some patients otherwise classified as having hydrostatic edema have concomitant permeability changes in the microvasculature and that permeability edema represents a spectrum of endothelial damage.

(JAMA 1987;257:953-956)

REFERENCES

Crandall ED, Staub NC, Goldberg HS, et al:  Recent developments in pulmonary edema . Ann Intern Med 1983;;99:808-822.
Loyd JE, Newman JH, Brigham KL:  Permeability pulmonary edema: Diagnosis and management . Arch Intern Med 1984;;144:143-147.
Brigham KL, Woolverton WC, Blake LH, et al:  Increased sheep lung vascular permeability caused by pseudomonas bacteremia . J Clin Invest 1974;; 54:792-804.
Anderson RR, Holliday RC, Driedger AA, et al:  Documentation of pulmonary capillary permeability in the adult respiratory distress syndrome . Am Rev Respir Dis 1979;;119:869-877.
Gorin AB, Kohler J, De Nardo G:  Non-invasive measurement of pulmonary transvascular protein flux in normal man . J Clin Invest 1980;;66:869-877.
Tatum JL, Burke TS, Sugerman HJ, et al:  Computerized scintigraphic technique for the evaluation of adult respiratory distress syndrome: Initial clinical trials . Radiology 1982;;143:237-241.
Dauber IM, Pluss WT, Van Grondelle A, et al:  Specificity and sensitivity of noninvasive measurement of pulmonary vascular protein leak . J Appl Physiol 1985;;59:564-574.
Okada RD, Pohost GM, Kirshenbaum HD, et al:  Radionuclide-determined change in pulmonary blood volume with exercise: Improved sensitivity of multigated blood-pool scanning in detecting coronary-artery disease . N Engl J Med 1979;;301:569-576.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Crandall ED, Staub NC, Goldberg HS, et al:  Recent developments in pulmonary edema . Ann Intern Med 1983;;99:808-822.
Loyd JE, Newman JH, Brigham KL:  Permeability pulmonary edema: Diagnosis and management . Arch Intern Med 1984;;144:143-147.
Brigham KL, Woolverton WC, Blake LH, et al:  Increased sheep lung vascular permeability caused by pseudomonas bacteremia . J Clin Invest 1974;; 54:792-804.
Anderson RR, Holliday RC, Driedger AA, et al:  Documentation of pulmonary capillary permeability in the adult respiratory distress syndrome . Am Rev Respir Dis 1979;;119:869-877.
Gorin AB, Kohler J, De Nardo G:  Non-invasive measurement of pulmonary transvascular protein flux in normal man . J Clin Invest 1980;;66:869-877.
Tatum JL, Burke TS, Sugerman HJ, et al:  Computerized scintigraphic technique for the evaluation of adult respiratory distress syndrome: Initial clinical trials . Radiology 1982;;143:237-241.
Dauber IM, Pluss WT, Van Grondelle A, et al:  Specificity and sensitivity of noninvasive measurement of pulmonary vascular protein leak . J Appl Physiol 1985;;59:564-574.
Okada RD, Pohost GM, Kirshenbaum HD, et al:  Radionuclide-determined change in pulmonary blood volume with exercise: Improved sensitivity of multigated blood-pool scanning in detecting coronary-artery disease . N Engl J Med 1979;;301:569-576.
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.