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Pulmonary Edema

  • Ronald L. Eisenberg
Chapter

Abstract

This chapter begins with the imaging findings in cardiogenic pulmonary edema and then addresses the various causes and appearances of non-cardiogenic pulmonary edema, including pulmonary hemorrhage and adult respiratory distress syndrome (ARDS).

Keywords

Pulmonary edema Non-cardiogenic pulmonary edema Pulmonary hemorrhage Adult respiratory distress syndrome (ARDS) 

Supplementary material

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Fig. e8.1 Interstitial edema in chronic cardiac insufficiency. (a) Bilateral lower lung predominance of interstitial opacities, as well as enlarged central vascular structures and cardiac enlargement (TIF 1470 kb)
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Fig. e8.1 Interstitial edema in chronic cardiac insufficiency. (b) Magnified view shows poor definition of vessels, thickening of interlobular septa (Kerley B lines) (black arrow), and peribronchial cuffing (white arrows) [2] (TIF 1906 kb)
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Fig. e8.2 Iatrogenic fluid overload. The patient had sustained trauma but had no underlying cardiac disease. There is distinct widening of the azygos vein (arrow) without significant cardiac enlargement and interstitial opacities [2] (TIF 1279 kb)
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Fig. e8.3 Alveolar hydrostatic edema in acute myocardial infarction. Bilateral interstitial and coalescent alveolar opacities with perihilar and lower lung predominance. Hazy opacity of the lower zones indicates associated layering pleural effusion [2] (TIF 1532 kb)
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Fig. e8.4 Hydrostatic pulmonary edema. Moderate ground-glass attenuation, thickening of interlobular septa and bronchovascular bundles (black arrow), and pleural effusion (white arrow) [2] (TIF 2056 kb)
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Fig. e8.5 Asymmetric pulmonary edema. Predominant involvement on the right in a woman who had received 12 liters of blood during orthopedic intervention of the femur while lying in the right lateral decubitus position [3] (TIF 751 kb)
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Fig. e8.6 Dependent pulmonary edema. (a) Preoperative image shows a typical pattern of pulmonary vascular congestion (TIF 1692 kb)
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Fig. e8.6 Dependent pulmonary edema. (b) Following VSD repair, there has been the development of pulmonary edema that primarily involves the apical regions (arrows). This reflects the Trendelenburg position of the patient during the operative procedure (TIF 1632 kb)
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Fig. e8.7 Pulmonary edema primarily involving the right upper lobe (arrow). (a) The patient developed acute mitral insufficiency related to a ruptured papillary muscle secondary to myocardial infarction [3] (TIF 1444 kb)
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Fig. e8.7 Pulmonary edema primarily involving the right upper lobe (arrow). (b) The patient developed acute mitral insufficiency related to a ruptured papillary muscle secondary to myocardial infarction [3] (TIF 597 kb)
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Fig. e8.8 Patchy asymmetric pattern of pulmonary edema in pulmonary emphysema. (a) Initial radiograph demonstrates a paucity of vascular markings in the right middle and upper zones, with increased interstitial markings elsewhere (TIF 753 kb)
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Fig. e8.8 Patchy asymmetric pattern of pulmonary edema in pulmonary emphysema. (b) With the onset of congestive heart failure, there is patchy interstitial and alveolar edema that does not affect the segments in which the vascularity had been severely diminished [1] (TIF 759 kb)
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Fig. e8.9 Pulmonary edema and COPD. (a) Enlargement of the cardiac silhouette and hyperexpansion of the lungs with flattening of the hemidiaphragms. The prominence of interstitial markings represents a combination of chronic obstructive pulmonary disease and elevated pulmonary venous pressure (TIF 1491 kb)
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Fig. e8.9 Pulmonary edema and COPD. (b) Enlargement of the cardiac silhouette and hyperexpansion of the lungs with flattening of the hemidiaphragms. The prominence of interstitial markings represents a combination of chronic obstructive pulmonary disease and elevated pulmonary venous pressure (TIF 2383 kb)
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Fig. e8.10 CT of alveolar edema. (a) In a patient with fluid overload and cardiac failure and a capillary wedge pressure of 28 mm Hg, there is diffuse alveolar edema with a central distribution and sparing of the periphery of the lungs (TIF 1031 kb)
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Fig. e8.10 CT of alveolar edema. (b) Corresponding radiograph shows the classic batwing pattern [3] (TIF 870 kb)
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Fig. e8.11 Hydrocarbon poisoning. Diffuse pulmonary edema pattern, with the alveolar consolidation most prominent in the central portion of the lungs [1] (TIF 578 kb)
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Fig. e8.12 Re-expansion pulmonary edema. (a) Large right pleural effusion (TIF 1547 kb)
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Fig. e8.12 Re-expansion pulmonary edema. (b) After insertion of a pigtail catheter, there has been virtually complete drainage of the pleural effusion (TIF 1506 kb)
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Fig. e8.12 Re-expansion pulmonary edema. (c) On an image obtained 2 hours later, there has been the development of massive re-expansion edema in the region of the previous pleural effusion (TIF 1297 kb)
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Fig. e8.13 Chronic renal failure. Typical butterfly pattern of perihilar alveolar opacities. Unlike pulmonary edema due to congestive heart failure, in uremic lung disease, the cardiac silhouette is of normal size [1] (TIF 621 kb)
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Fig. e8.14 Heroin abuse. (a) Initial radiograph obtained shortly after presentation to the emergency department shows bilateral areas of increased opacification, a finding consistent with acute lung injury (TIF 630 kb)
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Fig. e8.14 Heroin abuse. (b) Follow-up study obtained 2 days later shows complete clearing of the areas of increased opacity. Such rapid clearing is common in heroin-induced lung injury [4] (TIF 649 kb)
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Fig. e8.15 Cocaine abuse. Diffuse bilateral ground-glass opacities with superimposed thickening of inter- and intralobular interstitium [5] (TIF 601 kb)
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Fig. e8.16 Pulmonary hemorrhage. (a) Diffuse alveolar/ground-glass opacifications in the lower lobes bilaterally (TIF 1785 kb)
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Fig. e8.16 Pulmonary hemorrhage. (b) Diffuse alveolar/ground-glass opacifications in the lower lobes bilaterally (TIF 573 kb)
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Fig. e8.17 ARDS. (a) Initial image shows low lung volumes but no alveolar abnormality in this patient with autoimmune cirrhosis (TIF 1262 kb)
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Fig. e8.17 ARDS. Repeat studies (b) 12 hours and (c) 16 hours later demonstrate the development of a widespread and diffuse alveolar pattern involving all of the lungs (TIF 1307 kb)
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Fig. e8.17 ARDS. Repeat studies (b) 12 hours and (c) 16 hours later demonstrate the development of a widespread and diffuse alveolar pattern involving all of the lungs (TIF 1153 kb)

References

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    Eisenberg RL. Clinical Imaging: An Atlas of Differential Diagnosis. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2010.Google Scholar
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    Nemec SF, Bankier AA, Eisenberg RL. Lower lobe-predominant diseases of the lung. AJR. 2013;200:712–28.Google Scholar
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    Gluecker T, Capasso P, Schnyder P, et al. Clinical and radiological features of pulmonary edema. Radiographics. 1999;19:1507–31.CrossRefGoogle Scholar
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    Gotway MB, Marder SR, Hanks DK, et al. Thoracic complications of illicit drug use: an organ system approach. Radiographics. 2002;22:S119–35.CrossRefGoogle Scholar
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    Rossi SE, Erasmus JJ, McAdams HP, et al. Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics. 2000;20:1245–59.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ronald L. Eisenberg
    • 1
  1. 1.Department of RadiologyBeth Israel Deaconess Medical CenterBostonUSA

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