Sunday, June 20, 2010

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.

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