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][2]

Kerley B Lines

Kerley B lines are short parallel lines located at the lung periphery.

  • Represent distended interlobular septa
  • Usually less than 1 cm in length and parallel to one another at right angles to the pleura
  • May be seen in any zone but are most frequently observed at the lung bases

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.

Cephalization - Case courtesy of Dr Usman Bashir, via Radiopaedia.org[3]

Increased cardio-thoracic ratio

Cardio-thoracic ratio is useful for assessing an underlying cardiogenic cause of pulmunary edema.

  • A value > 0.5 or one half is consistent with enlargement of the heart.
Increased cardio-thoracic ratio - Case courtesy of A.Prof Frank Gaillard, via Radiopaedia.org[4]

Peribronchial Cuffing

Peribronchial cuffing is a radiologic sign, also referred to as peribronchial thickening or bronchial wall thickening.

  • Occurs when excess fluid buildup in the small airway.
  • Causes the area around the bronchus to appear more prominent on an X-ray.
  • 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.

Peribronchial cuffing - By C Michael Gibson, via Wikimedia.org[5]

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.

X-ray showing pulmonary edema via, radiopedia Case courtesy of Dr Jeremy Jones [6]

]


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

  1. 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.
  2. Murray JF (February 2011). "Pulmonary edema: pathophysiology and diagnosis". Int. J. Tuberc. Lung Dis. 15 (2): 155–60, i. PMID 21219673.
  3. Radiopaedia.org. From the case <"https://radiopaedia.org/cases/18342">rID: 18342
  4. Radiopaedia.org. From the case <"https://radiopaedia.org/cases/12334">rID: 12334
  5. <"https://www.wikidoc.org/index.php/File:Peribronchial_cuffing.png">File:Peribronchial cuffing.png at <"https://en.wikipedia.org/wiki/List_of_medical_wikis#WikiDoc" class="extiw" title="en:List of medical wikis">WikiDoc, <"https://creativecommons.org/licenses/by-sa/3.0" title="Creative Commons Attribution-Share Alike 3.0">CC BY-SA 3.0, <"https://commons.wikimedia.org/w/index.php?curid=65077075">
  6. https://radiopaedia.org/articles/pulmonary-alveolaroedema Source:Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 6463


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