Radiographic Patterns of Pulmonary Edema

Different patterns of pulmonary edema can be seen on chest radiographs depending on the cause. The table below summarizes principal (bold) and ancillary (italic) variables that should be evaluated. The vascular pedicle width was described previously (normal: 38-58 mm). Pulmonary blood volume is assessed as the size of the azygos vein (normal: 7-11 mm) and the degree of peripheral branching.

	Cardiogenic	Volume overload/Renal failure	Permeability
Distribution of pulmonary flow	Inverted (cephalization)	Balanced	Normal
Distribution of pulmonary edema	Basal and homogeneous from heart to chest wall ± perihilar	Central	Peripheral
Width of the vascular pedicle	Normal (acute heart failure) or widened (chronic heart failure)	Widedned	Normal or narrowed
Pulmonary blood volume	Normal or increased	Increased	Normal or decreased
Peribronchial cuffing	+	+	Uncommon
Septal lines	±	±	-
Pleural effusions	±	±	Rare
Air bronchograms	Rare	Rare	Present
Lung volumes	Decreased	Normal or increased	Normal
Cardiac size	Enlarged	Enlarged	Normal

References

Milne EN, Pistolesi M, Miniati M, Giuntini C. The radiologic distinction of cardiogenic and noncardiogenic edema. AJR Am J Roentgenol. 1985 May;144(5):879-94.