INTERSTITIAL VS ALVEOLAR

PULMONARY EDEMA
Classified into
Cardiogenic Non-cardiogenic

Cardiogenic pulmonary edema heart failure Heart failure

Left heart failure backward failure pulmonary congestion pulmonary edema Right heart failure backward failure systemic congestion doesnt cause pulmonary edema

PULMONARY EDEMA
Chest x ray screening tool Left heart failure:
Heart enlargement with the apex downward to the diaphragm Depend on the severity 1. Cranialization / cephalization (PCWP 10-15 mmHg) 2. Interstitial pulmonary edema (PCWP 20-25 mmHg) 3. Alveolar pulmonary edema (PCWP >25 mmHg)

PULMONARY EDEMA
Cranialization / cephalization
Pulmonary veins at the superior part of the lung >3-5:1 than the pulmonary veins at the inferior part of the lung. Vascular marking at the superior part of the lung is more crowded than the inferior part of the lung. Measure at equidistant from the hilar point.
Mechanism: Decreased vascular compliance at the lung base.
Hypoxic vasoconstriction phenomenon

PULMONARY EDEMA

Cranialization / Cephalization

PULMONARY EDEMA
Interstitial pulmonary edema
Interlobular septa thickening
Kerley B lung base : thickness 1mm, length 1-2cm, horizontal Kerley A dilatation of channel that connect the peripheral lymphatic channel to central lymphatic channel. Length up to 6cm, oblique at the central part Kerley C reticular at the lung base (en face Kerley B)

Peribronchial thickening at both hila Fluid in fissures Pleural effusion (Bilateral especially the right side)

PULMONARY EDEMA

Kerley B lines

PULMONARY EDEMA

PULMONARY EDEMA

Peribronchial thickening and fluid in the fissure

PULMONARY EDEMA

Interstitial pulmonary edema

PULMONARY EDEMA
Alveolar pulmonary edema
Infiltrates in the medial two third of the lung. Bats wing appearance Butterfly appearance Usually no air bronchogram

PULMONARY EDEMA

Alveolar pulmonary edema

PULMONARY EDEMA

Alveolar pulmonary edema

PULMONARY EDEMA
Non cardiogenic pulmonary edema
More peripherally No cranialization/cephalization Etiology:
Volume overload ARDS NSAID Neurogenic pulmonary edema (intracranial pressure>>) Drowned

PULMONARY EDEMA

Non cardiogenic pulmonary edema

 Alveolar pattern results from flooding of the end air spaces (acini) with fluid (pus, blood, edema) only rarely with cellular material. As individual acini become filled the fluid spreads to adjacent ones through the interalveolar pores. This results in the typical radiographic pattern of a poorly margined ("fluffy") density. The densities may spread and their borders coalesce. This may progress until all acini within a lung lobe are filled. There may be a sharp border at the edge of a lung lobe due to the pleura blocking further spread of the fluid into the adjacent lung lobe. As the number of fluid filled adjacent acini increases, the air filled, large and medium sized bronchi become evident as linear radiolucent branching structures (air bronchogram). The air-filled bronchi are surrounded by a fluid density and the bronchial wall and adjacent vessel are not seen. When a bronchus branches perpendicular to the x-ray beam it will be seen as a round radiolucent dot.