Pulmonary edema chest x ray
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
The diagnosis is confirmed on X-ray of the lungs, which shows increased fluid in the alveolar walls. Kerley B lines, increased vascular filling, pleural effusions, upper lobe diversion (increased blood flow to the higher parts of the lung) may be indicative of cardiogenic pulmonary edema, while patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema
Chest X Ray
An x-ray may be helpful in the diagnosis of pulmonary edema. Findings on an x-ray suggestive of pulmonary edema include:[1]
- Kerley B lines or thickening of the interlobular septa
- Cephalization
- Increased cardio-thoracic ratio
- Peribronchial cuffing
- Thickening of the fissures
- Increased vascular markings
- Interstitial edema
- Pleural effusions
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.
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Plain film: Mitral stenosis, Kerley B lines
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Plain film: Mitral stenosis, Kerley B lines
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Plain film: Mitral stenosis, Kerley B lines
Cephalization
Cephalization refers to the redistribution of blood into the upper lobe vessels.
- Pulmonary venous pressure exceeds 10 to 12 mmHg results in cephalization.
Shown below is a chest x ray with the yellow arrow which demonstrate cephalization of blood vessels.
Increased cardio-thoracic ratio
Cardio-thoracic ratio useful for assessing for an underlying cardiogenic cause
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.
Shown below is a chest x ray with the red arrows which demonstrate thickened bronchial walls that have a doughnut-like appearance.
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
References
- ↑ Pistolesi M, Miniati M, Milne EN, Giuntini C (September 1985). "The chest roentgenogram in pulmonary edema". Clin. Chest Med. 6 (3): 315–44. PMID 3907943.
- ↑ Radiopaedia.org. From the case <"https://radiopaedia.org/cases/18342">rID: 18342
- ↑ https://radiopaedia.org/articles/pulmonary-alveolaroedema Source:Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 6463