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INTERSTITIAL VS ALVEOLAR

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PULMONARY EDEMA Classified into

Cardiogenic

Non-cardiogenic Cardiogenic pulmonary edemaheart failure

Heart failure

Left heart failurebackward failurepulmonarycongestionpulmonary edema

Right heart failurebackward failuresystemic

congestiondoesnt cause pulmonary edema

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PULMONARY EDEMA Chest x rayscreening tool

Left heart failure:

Heart enlargement with the apex downward to thediaphragm

Depend on the severity

1. Cranialization / cephalization (PCWP 10-15 mmHg)

2. Interstitial pulmonary edema (PCWP 20-25 mmHg)

3. Alveolar pulmonary edema (PCWP >25 mmHg)

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PULMONARY EDEMA Cranialization / cephalization

Pulmonary veins at the superior part of the lung >3-5:1

than the pulmonary veins at the inferior part of the lung.

Vascular marking at the superior part of the lung is more

crowded than the inferior part of the lung.

Measure at equidistant from the hilar point.

Mechanism:

Decreased vascular compliance at the lung base.

Hypoxic vasoconstriction phenomenon

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PULMONARY EDEMA

Cranialization / Cephalization

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PULMONARY EDEMA Interstitial pulmonary edema

Interlobular septa thickening Kerley Blung base : thickness 1mm, length 1-2cm, horizontal

Kerley Adilatation of channel that connect the peripheral lymphatic

channel to central lymphatic channel. Length up to 6cm, oblique at the

central part

Kerley Creticular at the lung base (en face Kerley B)

Peribronchial thickening at both hila Fluid in fissures

Pleural effusion (Bilateral especially the right side)

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PULMONARY EDEMA

Kerley B lines

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PULMONARY EDEMA

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PULMONARY EDEMA

Peribronchial thickening and fluid in the fissure

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PULMONARY EDEMA

Interstitial pulmonary edema

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PULMONARY EDEMA Alveolar pulmonary edema

Infiltrates in the medial two third of the lung.

Bats wing appearance Butterfly appearance

Usually no air bronchogram

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PULMONARY EDEMA

Alveolar pulmonary edema

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PULMONARY EDEMA

Alveolar pulmonary edema

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PULMONARY EDEMA Non cardiogenic pulmonary edema

More peripherally

No cranialization/cephalization Etiology:

Volume overload

ARDS

NSAID

Neurogenic pulmonary edema (intracranial pressure>>)

Drowned

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PULMONARY EDEMA

Non cardiogenic pulmonary edema

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Alveolar pattern results from flooding of the end air spaces (acini)with fluid (pus, blood, edema) only rarely with cellular material. Asindividual acini become filled the fluid spreads to adjacent onesthrough the interalveolar pores. This results in the typicalradiographic pattern of a poorly margined ("fluffy") density. Thedensities may spread and their borders coalesce. This may progressuntil all acini within a lung lobe are filled. There may be a sharpborder at the edge of a lung lobe due to the pleura blocking furtherspread of the fluid into the adjacent lung lobe. As the number offluid filled adjacent acini increases, the air filled, large and mediumsized bronchi become evident as linear radiolucent branching

structures (air bronchogram). The air-filled bronchi are surroundedby a fluid density and the bronchial wall and adjacent vessel are notseen. When a bronchus branches perpendicular to the x-ray beam itwill be seen as a round radiolucent dot.