Overperfusion hypothesis

Since pulmonary hypertension due to arteriolar vasoconstriction is not uniform, alveolar edema is explained as overperfusion of unobstructed parts of the lung with no elevated pulmonary arterial pressure. The high blood flow could increase capillary filtration pressure, thus favoring the production of alveolar edema. Since inhaled nitric oxide improves arterial oxygenation in patients with high-altitude pulmonary edema by reducing pulmonary arterial pressure, a defect in nitric oxide production may be at least partially responsible for the pathogenesis of high-altitude pulmonary edema.

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