Question
A patient presents with frothy sputum, hemoptysis, dyspnea, and paroxysmal nocturnal dyspnea (PND). Lung biopsy reveals hemosiderin-laden macrophages (“heart failure cells”). In which of the following conditions is this finding least likely?
| A. |
Volume overload |
| B. |
Right ventricular failure |
| C. |
Pulmonary vein constriction |
| D. |
Hypoalbuminemia |
|
Correct Answer » B Explanation |
 |
– Symptoms: Dyspnea, paroxysmal nocturnal dyspnea (PND), hemoptysis, frothy sputum → classic pulmonary edema.
– Hemosiderin-laden macrophages (aka “heart failure cells”) → indicate chronic pulmonary congestion & hemorrhage.
– Most common in left heart failure or pulmonary venous hypertension.
– Right-sided heart failure causes systemic venous congestion, not pulmonary congestion, and affects liver, jugular veins, periphery.
– Least likely to show hemosiderin-laden macrophages.
Incorrect Options:
A. Volume overload – ↑ atrial & pulmonary venous pressures, can cause edema & hemorrhage.
C. Pulmonary vein constriction – ↑ venous pressures, microhemorrhages, extravasation of RBCs → hemosiderin deposition.
D. Hypoalbuminemia – ↓ oncotic pressure → fluid shift to alveoli; may contribute to pulmonary edema, secondary hemorrhage.