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Acute Pulmonary Edema and Compression Garments

      To the Editor
      I read with interest the Case Report entitled “Acute Pulmonary Edema Associated With Placement of Waist-High, Custom-Fit Compression Stockings” by McCardell et al.
      • McCardell CS
      • Berge KH
      • Ijaz M
      • Lanier WL
      Acute pulmonary edema associated with placement of waist-high, custom-fit compression stockings.
      Their discussion cited no other cases of patients treated similarly who developed pulmonary edema. I contend, however, that numerous clinical instances have occurred. As a resident in internal medicine at the Syracuse Upstate New York Medical Center during 1960 and 1961,1 treated a patient who was admitted for exacerbation of chronic heart failure. His extremely edematous legs, with edema to the upper thighs, were treated with Ace bandages applied in a figure-of-8 compression pattern. Within 2 hours, acute pulmonary edema developed, which responded to a digitalis preparation and intravenous morphine treatment.
      We did not think this surprising because treatment of acute pulmonary edema at that time included the application of narrow tourniquets on 3 of 4 limbs sufficient to occlude venous return, which were then alternated, so that only 3 limbs at a time were occluded, but they were different limbs. Application of Ace bandages achieved the opposite effect.
      I think an educated guess is that numerous such instances have occurred. The use of compression garments to treat lymphedema is effective, and in cases of congestive heart failure, the edema is not obstructed by diseased lymphatics but is waiting to be mobilized from the extravascular spaces.

      Uncited References

        • McCardell CS
        • Berge KH
        • Ijaz M
        • Lanier WL
        Acute pulmonary edema associated with placement of waist-high, custom-fit compression stockings.
        Mayo Clin Proc. 1999; 74: 478-480

      Linked Article

      • Acute Pulmonary Edema and Compression Garments: In reply
        Mayo Clinic ProceedingsVol. 74Issue 9
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          We thank Dr Nicholas for his comments. We agree that many similar episodes of pulmonary edema have likely resulted from compression garments. However, we were surprised to find that an extensive MEDLINE search for the years 1966-1999 failed to reveal any documented cases of pulmonary edema resulting from a similar mechanism. We appreciate Dr Nicholas's corroboration of our premise concerning the potentially serious consequences of even simple compression garments in the patient with the potential for marginally compensated cardiac function.
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