Lung congestion, distention of blood vessels in the lungs and

filling of the alveoli with blood as a result of an infection,

high blood pressure, or cardiac insufficiencies (i.e., inability of the
heart to function adequately). The alveoli in the lungs are minute
air sacs where carbon dioxide and oxygen exchange occurs.
Active congestion of the lungs is caused by infective agents or
irritating gases, liquids, and particles. The alveolar walls and the
capillaries in them become distended with blood. Passive
congestion is due either to high blood pressure in the capillaries,
caused by a cardiac disorder, or to relaxation of the blood
capillaries followed by blood seepage.
Left-sided heart failure—inability of the left side of the heart to
pump sufficient blood into the general circulation—causes back
pressure on the pulmonary vessels delivering oxygenated blood
to the heart. The blood pressure becomes high in the alveolar
capillaries, and they begin to distend. Eventually the pressure
becomes too great, and blood escapes through the capillary wall
into the alveoli, flooding them. Mitral stenosis, narrowing of the
valve between the upper and lower chambers in the left side of
the heart, causes chronic passive congestion. Iron pigment from
the blood that congests the alveoli spreads throughout
the lung tissue and causes deterioration of tissue and formation of
scar tissue. The walls of the alveoli also thicken and gas
exchange is greatly impaired. The affected person shows difficulty
in breathing, there is a bloody discharge, and the skin takes on a
bluish tint as the disease progresses.
Passive congestion due to relaxation of the blood vessels occurs
in bedridden patients with weak heart action. Blood accumulates
in the lower part of the lungs, although there is usually enough
unaffected lung tissue for respiration. The major complication
arises in mild cases of pneumonia, when the remaining
functioning tissue becomes infected.