Congestive heart failure chest x ray: Difference between revisions
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* Once the heart failure is advanced, the enlarged [[right ventricle]] forms the left border of the cardiac silhouette. | * Once the heart failure is advanced, the enlarged [[right ventricle]] forms the left border of the cardiac silhouette. | ||
* The presence of enlargement of vessels to the upper lobes, peribronchial cuffing, and pulmonary interstitial and alveolar edema are all indicative of pulmonary venous hypertension. | * The presence of enlargement of vessels to the upper lobes, peribronchial cuffing, and pulmonary interstitial and alveolar edema are all indicative of pulmonary venous hypertension. | ||
Chest x-ray findings include: | |||
#[[Kerley B lines]] or thickening of the interlobular septa | |||
#[[Peribronchial cuffing]] | |||
#Thickening of the fissures | |||
#Cephalization | |||
#Increased vascular markings | |||
#[[Interstitial edema]] | |||
#[[Pleural effusion]]s | |||
==Differentiating Cardiogenic Versus Noncardiogenic Pulmonary Edema== | |||
==Cardiogenic Pulmonary Edema== | |||
[[Image:Interstitial edema.png|thumb|left]] Cardiogenic pulmonary edema can be distinguished from noncardiogenic pulmonary edema by the presence of redistribution of blood flow to the upper lobes (increased blood flow to the higher parts of the lung) and interstitial edema. | |||
{{clr}} | |||
===Noncardiogenic Pulmonary Edema=== | |||
[[Image:Pulmonary alveolar edema.png|left|thumb]] In contrast, patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema.{{clr}} | |||
==Correlation of Chest X-Ray Findings with Pulmonary Capillary Wedge Pressure== | |||
*'''Normal''':5-10 mm Hg | |||
*'''Cephalization''': 10-15 mm Hg | |||
*'''Kerley B Lines''': 15-20 mm Hg | |||
*'''Pulmonary Interstitial Edema''': 20-25 mm Hg | |||
* '''Pulmonary Alveolar Edema''': > 25 mm Hg | |||
==Kerley B Lines== | |||
[[Kerley B lines]] are short parallel lines at the lung periphery. These lines represent distended interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the [[pleura]]. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs. | |||
<gallery> | |||
Image:Kerley B 001.jpg|Plain film: [[Mitral stenosis]], Kerley B lines | |||
Image:Kerley B 002.jpg|Plain film: [[Mitral stenosis]], Kerley B lines | |||
Image:Kerley B 003.jpg|Plain film: [[Mitral stenosis]], Kerley B lines | |||
</gallery> | |||
==Peribronchial Cuffing== | |||
[[Image:Peribronchial cuffing.png|thumb|left|The red arrows point to thickened bronchial walls that have a doughnut-like appearance.]] [[Peribronchial cuffing]] is an abnormality on a chest x-ray whereby the usually thin bronchial walls are thickened and take on a doughnut-like appearance.{{clr}} | |||
==Cephalization== | |||
[[Image:Cephalization.png|left|thumb]]Cephalization refers to the redistribution of blood into the upper lobe vessels. It has been hypothesized that once the hydrostatic pressure exceeds 10 mm Hg, then fluid begins to leak into the interstitium of the lung. This excess fluid initially compresses the lower lobe vessels, perhaps as a result of gravity. After this, the upper lobe vessels are recruited to distribute a greater volume of blood. In order to carry a greater volume of blood, the upper lobe vessels increase in size.{{clr}} | |||
== References== | == References== | ||
Revision as of 02:40, 3 April 2012
| Congestive Heart Failure Microchapters |
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Pathophysiology |
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Differentiating Congestive heart failure from other Diseases |
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Diagnosis |
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Treatment |
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Medical Therapy: |
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Surgical Therapy: |
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ACC/AHA Guideline Recommendations
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Specific Groups: |
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Congestive heart failure chest x ray On the Web |
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Directions to Hospitals Treating Congestive heart failure chest x ray |
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Risk calculators and risk factors for Congestive heart failure chest x ray |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The chest x-ray in the patient with heart failure shows cardiomegaly (cardiac enlargement and pulmonary congestion (Kerley B lines, and in some cases pleural effusion)
Chest X-ray
- Since the LV often dilates in the anteroposterior direction, the cardiac silhouette may appear deceptively normal.
- Once the heart failure is advanced, the enlarged right ventricle forms the left border of the cardiac silhouette.
- The presence of enlargement of vessels to the upper lobes, peribronchial cuffing, and pulmonary interstitial and alveolar edema are all indicative of pulmonary venous hypertension.
Chest x-ray findings include:
- Kerley B lines or thickening of the interlobular septa
- Peribronchial cuffing
- Thickening of the fissures
- Cephalization
- Increased vascular markings
- Interstitial edema
- Pleural effusions
Differentiating Cardiogenic Versus Noncardiogenic Pulmonary Edema
Cardiogenic Pulmonary Edema
Cardiogenic pulmonary edema can be distinguished from noncardiogenic pulmonary edema by the presence of redistribution of blood flow to the upper lobes (increased blood flow to the higher parts of the lung) and interstitial edema.
Noncardiogenic Pulmonary Edema
In contrast, patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema.
Correlation of Chest X-Ray Findings with Pulmonary Capillary Wedge Pressure
- Normal:5-10 mm Hg
- Cephalization: 10-15 mm Hg
- Kerley B Lines: 15-20 mm Hg
- Pulmonary Interstitial Edema: 20-25 mm Hg
- Pulmonary Alveolar Edema: > 25 mm Hg
Kerley B Lines
Kerley B lines are short parallel lines at the lung periphery. These lines represent distended interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the pleura. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs.
-
Plain film: Mitral stenosis, Kerley B lines
-
Plain film: Mitral stenosis, Kerley B lines
-
Plain film: Mitral stenosis, Kerley B lines
Peribronchial Cuffing
Peribronchial cuffing is an abnormality on a chest x-ray whereby the usually thin bronchial walls are thickened and take on a doughnut-like appearance.
Cephalization
Cephalization refers to the redistribution of blood into the upper lobe vessels. It has been hypothesized that once the hydrostatic pressure exceeds 10 mm Hg, then fluid begins to leak into the interstitium of the lung. This excess fluid initially compresses the lower lobe vessels, perhaps as a result of gravity. After this, the upper lobe vessels are recruited to distribute a greater volume of blood. In order to carry a greater volume of blood, the upper lobe vessels increase in size.