Pulmonary Edema

Adult respiratory distress syndrome (ARDS)

High magnification of exudative stage of ARDS showing hyaline membranes, large atypical type 2 pneumocytes, and inflammatory cells. The alveolar structures are obscured by the intense inflammatory infiltrate.

FIGURE 1.26. A 40-year-old man who developed a left pneumothorax while being ventilated for acute respiratory distress syndrome (ARDS). A: Baseline chest radiograph shows diffuse parenchymal airspace opacity compatible with ARDS. B: A chest radiograph obtained during respiratory deterioration shows a new lucency over the region of left hemidiaphragm (deep anterior sulcus). There is also increased depth of the lateral costophrenic sulcus. The thin white line of pneumothorax is evident superi...

FIGURE 82.1. Chest radiograph of older child with congestive heart failure. Note cardiac enlargement and evidence of pulmonary venous congestion.

FIG. 16.2. Hyaline membrane disease and bronchopulmonary dysplasia. Hyaline membrane disease. This is one of twins born at 31 weeks' gestation. The chest radiograph shows hypoaeration, diffusely opaque lung fields, air bronchograms, and loss of normal vascular shadows.

FIG. 16.12. Pulmonary edema: varying causes and configurations. A: Acute glomerulonephritis. Note extensive interstitial pulmonary edema, moderate cardiomegaly, and moderate bilateral pleural effusions. The findings would be difficult to differentiate from acute myocarditis with failure. B: Near drowning. Note extensive fluffy, nodular infiltrates distributed throughout both lungs. In other patients, the infiltrates may be more diffuse or hazy and less nodular. C: Rheumatic pneumonia. This ...

<bold><italic>FIGURE 6.64.</bold></bold> Apical four-chamber view recorded in an elderly patient with long-standing mild systemic hypertension and congestive heart failure due to predominantly diastolic dysfunction. Note the evidence of significant atrial enlargement, which is a marker of long-standing diastolic dysfunction. LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle

<bold>Fig C 1-24 Pulmonary edema in pulmonary emphysema.</bold> (A) Initial chest radiograph demonstrates a paucity of vascular markings in the right middle and upper zones along with increased interstitial markings elsewhere. (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.

<bold>Fig C 2-1 Congestive heart failure.</bold> Diffuse bilateral symmetric infiltration of the central portion of the lungs along with relative sparing of the periphery produces the butterfly, or bat's wing, pattern. The margins of the edematous lung are sharply defined. The consolidation is fairly homogeneous and is associated with a well-defined air bronchogram on both sides.⁶

Figure 18-41<bold>ACUTE PULMONARY EDEMA. PA Chest.</bold>Observe the bilateral and symmetric alveolar densities in the perihilar zones, creating a characteristic bat-wing appearance (<italic>arrows</bold>). <bold><italic>COMMENT:</bold></bold>fiuffy increased density in a perihilar distribution, creating a batwing or angel-wingpattern. There is relative sparing of themore peripheral zones of the lung ?elds. (1,5) (Fig. 18-41) Airbronchograms become evident as the edema becomes moreopaque. This type of edema most commo...

Figure 18-42<bold>CHRONIC PULMONARY EDEMA. PA Chest.</bold>A close-up of the lung base demonstrates pulmonary congestion with a hazy appearance to the aerated lung, multiple Kerley B lines (<italic>arrows</bold>), and a small pleural effusion.<bold><italic>COMMENT:</bold></bold>Pulmonary congestion secondary to congestive cardiac failure displays the features seen here. Ancillary findings include upper lobe venous distension and peribronchial thickening.

A 72-year-old woman in pulmonary edema. The left ventricle is enlarged. The left atrial appendage portion of the left heart border is nearly convex (arrow). The upper lobe vessels are dilated and indistinct. The diffuse and inhomogeneous infiltrates involve the lower lungs, sparing the upper lobes.

<bold>Figure 4.27. Kerley lines in patients with congestive heart failure. A,</bold> AP radiograph shows prominent interstitial markings in both bases with a fine interlacing pattern. <bold>B,</bold> detail view shows the linear horizontal Kerley B-lines in the periphery. <bold>C</bold> and <bold>D,</bold> detail views of two other patients show similar findings.

<bold>Figure 4.88. Pulmonary edema.</bold> There are fluffy alveolar densities throughout both lungs. The cardiac silhouette is obscured in this patient with congestive heart failure.

<bold>Figure 5.33. Congestive heart failure and pulmonary edema. A.</bold> Frontal view shows mild pulmonary edema and pulmonary venous engorgement. <bold>B.</bold> Detail view shows the edema and prominent septal (Kerley) lines. <bold>C.</bold> Detail view in another patient shows the prominent horizontal Kerley lines.

FIG. 16.8. Pulmonary edema: radiographic findings. A: Kerley B lines in interstitial pulmonary edema. These are short opaque lines (arrowhead) seen best along the lateral aspects of the lungs. Thickened interlobular septa from lymphangitic spread of tumor can produce an identical appearance. B: Diffuse alveolar pulmonary edema shows ill-defined opacification in both lungs that is most prominent in the perihilar regions. C: Classical butterfly pattern of pulmonary edema in a uremic patient.

Diffuse alveolar damage (adult respiratory distress syndrome, ARDS). In ARDS, type I cells die as a result of diffuse alveolar damage. Intra-alveolar edema follows, after which there is formation of hyaline membranes composed of proteinaceous exudate and cell debris. In the acute phase, the lungs are markedly congested and heavy. Type II cells multiply to line the alveolar surface. Interstitial inflammation is characteristic. The lesion may heal completely or progress to interstitial fibrosis.