Pulmonary alveolar edema

Last revised by Patrick J Rock on 22 May 2021

Pulmonary alveolar edema is a particular pattern of pulmonary edema where most of the fluid build up is in the alveolar spaces. The onset of alveolar edema may also be associated with direct pressure-induced damage to the alveolar epithelium. It can sometimes have a central perihilar pattern. Alveolar pulmonary edema is often preceded by interstitial pulmonary edema and usually develops once the pulmonary venous pressure exceeds 30 mmHg 2.

Radiographic features

Plain radiograph

On chest radiographs, there are often bilateral opacities that extend in a fan-shape outwards from the hilum in a ‘batwing’ pattern. With worsening alveolar edema, the lung opacification can become increasingly homogeneous. Air bronchograms may be seen with alveolar edema 2.

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