Acute onset dyspnea with a cough producing pink frothy sputum is most indicative of which condition?

• A. Pneumonia
• B. Pulmonary edema
• C. Asthma exacerbation
• D. Pulmonary embolism

Answer: (B)

Pink frothy sputum with acute shortness of breath points to fluid filling the air sacs in the lungs from left-sided heart failure, i.e., pulmonary edema. The edema fluid leaks into the alveoli, mixes with air and a little blood, and disrupts gas exchange, producing sudden dyspnea and crackles on exam. This pattern is much more typical of pulmonary edema than the other conditions: pneumonia usually brings fever and a purulent, potentially non-frothy sputum with localized findings of infection; asthma exacerbation presents with wheezing and reversible airway obstruction; pulmonary embolism often causes sudden dyspnea with chest pain and might have clear or blood-tinged sputum rather than pink frothy sputum.