Significance of changes in the pulmonary lymph flow in acute and chronic experimental pulmonary edema

Leeds, Sanford E.; Uhley, Herman N.; Sampson, John J.; Friedman, Meyer

doi:10.1016/0002-9610(67)90380-7

Cited by 9 publications

(4 citation statements)

References 8 publications

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“… 17 Mediastinal lymph node enlargement has been reported to be present in half of the patients with chronic obstructive pulmonary disease in one series, irrespective of the degree of airflow obstruction, 6 and between 35% and 66% in patients with severe chronic cardiac failure, 11–13 15 16 where lymphadenopathy may be secondary to raised left atrial filling pressures resulting in increased lymphatic fluid. 12 18–20 …”

Section: Introductionmentioning

confidence: 99%

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

Evison

Morris²,

Martin³

et al. 2014

BMJ Open Resp Res

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BackgroundIsolated mediastinal and/or hilar lymphadenopathy (IMHL) may be caused by benign and malignant disorders or be ‘reactive’. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a reported low negative predictive value (NPV) in IMHL, necessitating mediastinoscopy in selected patients. The aim of this study was to examine the NPV of EBUS-TBNA in an IMHL population and determine whether clinical variables differentiate between pathological and reactive IMHL.MethodsAnalysis of a prospectively maintained database of consecutive patients with IMHL referred to a single UK centre for EBUS-TBNA.Results100 patients with IMHL had EBUS-TBNA during the study (March 2010–February 2013), mean age 58.6±15.7 years, 63% men, 70% white British and mean follow-up 16.8±8.6 months. Pathological cause of IMHL established in 52 patients (sarcoidosis n=20, tuberculosis n=18, carcinoma n=7, lymphoma n=6, benign cyst n=1), 43 from EBUS-TBNA. 48/57 negative EBUS-TBNA samples were true negatives reflecting reactive lymphadenopathy in 48%. The diagnostic accuracy of EBUS-TBNA was 91% and NPV was 84.2% (95% CI 72.6% to 91.5%). Multivariate analysis of clinical covariates showed age (odds ratio (OR) 1.07, 95% CI 1.01 to 1.13; p=0.033), the presence of a relevant comorbidity (OR 9.49, 95% CI 2.20 to 41.04; p=0.003) and maximum lymph node size (OR 0.70, 95% CI 0.59 to 0.83; p=0.00004) to differentiate between reactive and pathological IMHL. Stratification of the study population according to comorbidity and maximum lymph node size (<20 mm) identified a low-risk cohort (n=32) where the NPV of EBUS-TBNA was 93.8% (95% CI 79.9% to 98.3%).ConclusionsReactive lymphadenopathy accounts for a significant proportion of patients with IMHL. In carefully selected patients with IMHL and a negative EBUS-TBNA, surveillance rather than further invasive sampling may be an appropriate strategy.

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Section: Introductionmentioning

confidence: 99%

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

Evison

Morris²,

Martin³

et al. 2014

BMJ Open Resp Res

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“…Rabin and Meyer [46] demonstrated that lymph flow in the right duct significantly increased with the elevation of the left atrial pressure in dogs. Leeds et al [47] concurred that an elevation of the left atrial pressure to 40 cm of water led to an immediate rise in the right duct flow in dogs. More recently, Wagner and associates [48] reported that increased bronchial arterial perfusion for 90 min resulted in an average 35 % rise in lung lymph flow in sheep.…”

Section: Pulmonary Lymph Flowmentioning

confidence: 99%

The Effect of Cardiopulmonary Lymphatic Obstruction on Heart and Lung Function

Cui

Urschel²,

Petrelli³

2001

Thorac cardiovasc Surg

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Many thoracic surgical procedures involve excision or destruction of intrathoracic and mediastinal lymphatics. It is widely assumed that the mediastinal lymphatic system is surgically expendable, and that destruction of mediastinal lymphatics has no significant adverse physiological effect. Cardiac lymphatic obstruction may give rise to cardiac lymphedema and impaired cardiac function. Similarly, obstruction of pulmonary lymphatics may result in pulmonary perivascular lymphedema, endothelial injury, and pulmonary artery hypertension. This review summarizes the possible deleterious effects of intrathoracic lymphatic destruction and the benefits of pharmacological and surgical enhancement of active lymph drainage.

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“…Many factors promote pulmonary lymph flow, including the elevation of the left atrial pressure, increased bronchial arterial perfusion, hemodilution, increased cardiac output, and so on. In contrast, lymph flow may decline with the elevation of lymphatic outflow pressure; the effective resistance of the extrapulmonary part of the lymphatic system was larger than the resistance of the lymphatics in the lungs, and it may limit the maximal flow of lymph from edematous lungs [56][57][58][59][60][61][62][63][64][65][66] .…”

Section: Pulmonary Lymphatic Vessels and Lymph Flowmentioning

confidence: 99%

Cardiopulmonary Dysfunction Caused by Mediastinal Lymph Flow Impairment

Cui¹

2016

Journal of Respiratory Research

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The important effect of mediastinal lymph flow has been overlooked in most textbooks for over three centuries, and recent progresses in lymphatic vascular biology provide a new way to discover the effect of mediastinal lymph flow impairment. Different from conventional view about lymph flow impairment, which merely refers to tissue edema other than specific tissue or organ injury, mediastinal lymph flow impairment can bring a fatal consequence. Mediastinal lymph flow impairment may cause cardiopulmonary dysfunction by interrupting both the cardiac contraction manner of cardiomyocytes "asynchronized" contraction and pulmonary perivascular lymphatic remodeling.

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Significance of changes in the pulmonary lymph flow in acute and chronic experimental pulmonary edema

Cited by 9 publications

References 8 publications

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

The Effect of Cardiopulmonary Lymphatic Obstruction on Heart and Lung Function

Cardiopulmonary Dysfunction Caused by Mediastinal Lymph Flow Impairment

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