What symptoms mean I am developing an acute pulmonary edema episode that requires emergency care?

Sudden worsening of shortness of breath at rest, a rapid rise in oxygen requirement, pink frothy sputum, new or worsening chest tightness, and a rapid drop in blood pressure are red‑flag signs. If you notice any of these, call emergency services immediately because rapid fluid accumulation in the lungs can be life‑threatening in PVOD.

How can doctors tell that my pulmonary hypertension is caused by PVOD rather than another type of PAH without doing an invasive lung biopsy?

Clinicians look for a combination of clues: high‑resolution CT showing centrilobular ground‑glass opacities, thickened interlobular septa, and enlarged mediastinal lymph nodes; a disproportionately low diffusing capacity for carbon monoxide (DLCO < 60% predicted); and a normal or only mildly elevated pulmonary capillary wedge pressure on right‑heart catheterization. When these features cluster, the suspicion for PVOD is strong enough to guide management without a biopsy.

Are there pulmonary‑hypertension drugs that I should avoid because they can make PVOD worse?

Yes. Classic vasodilators such as epoprostenol, treprostinil, and high‑dose sildenafil can increase blood flow into the obstructed veins and precipitate pulmonary edema. Many clinicians start with very low‑dose, short‑acting agents (e.g., inhaled nitric oxide) only in a monitored setting, and they often avoid long‑acting oral therapies altogether.

What are the definitive treatment options and when should I be referred for a lung transplant?

The only curative option is lung (or heart‑lung) transplantation. Because PVOD can deteriorate quickly, referral to a transplant center should occur as soon as the diagnosis is made, especially if the patient is NYHA functional class III–IV, has a DLCO < 40%, or shows signs of right‑heart failure. Bridge therapies may include cautious use of low‑dose diuretics, supplemental oxygen, and, in selected cases, short‑term inhaled nitric oxide while awaiting transplant evaluation.

Pulmonary veno-occlusive disease

A rare, often fatal disorder in which fibrous tissue blocks the pulmonary veins, leading to pulmonary arterial hypertension and rapid clinical decline.

Overview

Pulmonary veno-occlusive disease (PVOD) is characterized by the blockage (occlusion) of the blood vessels that carry oxygen‑rich (oxygenated) blood from the lungs to the heart (the pulmonary veins). The occlusion is caused by a buildup of abnormal fibrous tissue in the small veins, which narrows the vessels and impairs blood flow. Because blood flow through the lungs is difficult, pressure rises in the vessels that carry blood that needs to be oxygenated to the lungs from the heart (pulmonary arteries). Increased pressure in these vessels is known as pulmonary arterial hypertension.

The problems with blood flow in PVOD also impair the delivery of oxygenated blood to the rest of the body, leading to the signs and symptoms of the condition. Shortness of breath (dyspnea) and tiredness (fatigue) during exertion are the most common symptoms. Other common features include dizziness, a lack of energy (lethargy), difficulty breathing when lying down, and a cough that does not go away. As the condition worsens, affected individuals can develop a bluish tint to the skin (cyanosis), chest pains, fainting spells, and an accumulation of fluid in the lungs (pulmonary edema).

Certain features commonly seen in people with PVOD can be identified using a CT scan. One of these features, seen in the lungs of affected individuals, is an abnormality described as centrilobular ground‑glass opacities. Affected individuals also have abnormal thickening of certain tissues in the lungs, described as septal lines. In addition, lymph nodes in the chest (mediastinal lymph nodes) are abnormally enlarged.

PVOD can begin at any age, and the blood‑flow problems worsen over time. Because of the increased blood pressure in the pulmonary arteries, the heart must work harder than normal to pump blood to the lungs, which can eventually lead to fatal heart failure. Most people with this severe disorder do not live more than 2 years after diagnosis.

Frequency

The exact prevalence of PVOD is unknown. Many cases are likely misdiagnosed as idiopathic pulmonary arterial hypertension, which is increased blood pressure in the pulmonary arteries without a known cause. Research suggests that 5 to 25 percent of people diagnosed with idiopathic pulmonary arterial hypertension have PVOD. Based on these numbers, PVOD is thought to affect an estimated 1 to 2 per 10 million people.

Causes

The primary genetic cause of PVOD is mutations in the EIF2AK4 gene. Mutations in other genes may cause a small percentage of cases. Other suspected causes of PVOD include viral infection and exposure to toxic chemicals, including certain chemotherapy drugs.

The protein produced from the EIF2AK4 gene helps cells respond appropriately to changes that could damage the cell. For example, when the level of protein building blocks (amino acids) in a cell falls too low, the activity of the EIF2AK4 protein helps reduce the production of other proteins, which conserves amino acids. The EIF2AK4 gene mutations involved in PVOD likely eliminate functional EIF2AK4 protein; however, it is unknown how absence of this protein's function leads to the pulmonary vessel abnormalities that underlie PVOD.

Learn more about the genes associated with Pulmonary veno-occlusive disease

BMPR2
EIF2AK4

Inheritance

When caused by mutations in the EIF2AK4 gene, PVOD is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition.

In contrast, when caused by mutations in another gene, the condition can have an autosomal dominant pattern of inheritance, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In these cases, one parent of an affected individual typically has increased blood pressure in the vessels of the lungs.

Other Names

Isolated pulmonary venous sclerosis
Obstructive disease of the pulmonary veins
Pulmonary venoocclusive disease
PVOD
Venous form of primary pulmonary hypertension

Additional Information & Resources

Genetic Testing Information

Genetic Testing Registry: Pulmonary venoocclusive disease 1

Genetic and Rare Diseases Information Center

Pulmonary venoocclusive disease

Patient Support and Advocacy Resources

National Organization for Rare Disorders (NORD)

Clinical Trials

ClinicalTrials.gov

Catalog of Genes and Diseases from OMIM

PULMONARY VENOOCCLUSIVE DISEASE 1, AUTOSOMAL DOMINANT; PVOD1
PULMONARY VENOOCCLUSIVE DISEASE 2, AUTOSOMAL RECESSIVE; PVOD2

Scientific Articles on PubMed

PubMed

References

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Mandel J, Mark EJ, Hales CA. Pulmonary veno-occlusive disease. Am J Respir Crit Care Med. 2000 Nov;162(5):1964-73. doi:10.1164/ajrccm.162.5.9912045.
Montani D, Achouh L, Dorfmuller P, Le Pavec J, Sztrymf B, Tcherakian C, Rabiller A, Haque R, Sitbon O, Jais X, Dartevelle P, Maitre S, Capron F, Musset D, Simonneau G, Humbert M. Pulmonary veno-occlusive disease: clinical, functional, radiologic, and hemodynamic characteristics and outcome of 24 cases confirmed by histology. Medicine (Baltimore). 2008 Jul;87(4):220-233. doi:10.1097/MD.0b013e31818193bb.
Runo JR, Vnencak-Jones CL, Prince M, Loyd JE, Wheeler L, Robbins IM, Lane KB, Newman JH, Johnson J, Nichols WC, Phillips JA 3rd. Pulmonary veno-occlusive disease caused by an inherited mutation in bone morphogenetic protein receptor II. Am J Respir Crit Care Med. 2003 Mar 15;167(6):889-94. doi:10.1164/rccm.200208-861OC. Epub 2002 Nov 21.