Pulmonary edema
Updates to Article Attributes
Pulmonary oedema is a broad descriptive term and is usually defined as an abnormal accumulation of fluid in the extra-vascular compartments of the lung 1.
Pathology
One method of classifying pulmonary oedema is as four main categories on the basis of pathophysiology which include:
- increased hydrostatic pressure oedema
- two pathophysiological and radiological phases are recognized in the development of pressure oedema
- these phases are virtually identical for left-sided heart failure and fluid overload
- permeability oedema with diffuse alveolar damage (DAD)
- permeability oedema without diffuse alveolar damage
- mixed oedema due to simultaneous increased hydrostatic pressure and permeability changes
It can arise from a range of both cardiogenic and non-cardiogenic causes.
Causes
- cardiogenic pulmonary oedema:
-
non cardiogenic pulmonary oedema: useful mnemonic: NOTCARDIAC
- fluid overload
- pulmonary oedema with acute asthma
- post-obstructive pulmonary oedema/ post intubation pulmonary oedema
- pulmonary oedema in pulmonary thromboembolism
- pulmonary oedema due to air embolism
- pulmonary veno-occlusive disease
- near drowning pulmonary oedema / asphyxiation pulmonary oedema
- ARDS - pulmonary oedema with diffuse alveolar damage
- heroin-induced pulmonary oedema
- pulmonary oedema following administration of cytokines
- transfusion related acute lung injury
- high-altitude pulmonary oedema
- neurogenic pulmonary oedema
- reperfusion pulmonary oedema
- pulmonary oedema following lung transplantation
- re-expansion pulmonary oedema
- post-pneumonectomy pulmonary oedema
- post lung volume reduction pulmonary oedema
- pulmonary oedema from anti snake venom administration 8
Radiographic features
Plain radiograph
The chest radiograph still remains the most practical and useful method of radiologically assessing and quantifying pulmonary oedema 3-4.
Features useful for broadly assessing pulmonary oedema on a plain radiograph include:
- pulmonary venous engorgement / pulmonary blood flow distribution / upper lobe pulmonary venous diversion
- cardiac size/cardio-thoracic ratio: useful for assessing for an underlying cardiogenic cause or association
bat wing pulmonary opacities- presence of peri-bronchial cuffing
- septal lines: Kerley lines
- bat wing pulmonary opacities
- pleural effusions
-
pulmonary venous engorgement/ pulmonary blood flow distribution /upper lobe pulmonary venous diversion
Some of these features can vary depending on the cause and is best addressed on individual articles 1. There is general progression of signs of CXR that occur as pulmonary capillary wedge pressure (PCWP) increases, as discuss in pulmonary oedema grading.
Differential diagnosis
General imaging differential considerations include:
- diffuse pulmonary haemorrhage: has no dependent gradient and usually no pleural effusion
- diffuse pulmonary infection 6: usually no dependent gradient
See also
- +<li>
- +<a href="/articles/pulmonary-venous-engorgement">pulmonary venous engorgement</a> / pulmonary blood flow distribution / <a href="/articles/upper-lobe-pulmonary-venous-diversion">upper lobe pulmonary venous diversion</a>
- +</li>
-<li><a href="/articles/bat-wing-pulmonary-opacities-1">bat wing pulmonary opacities</a></li>- +<li><a href="/articles/bat-wing-pulmonary-opacities-1">bat wing pulmonary opacities</a></li>
-<li>-<a href="/articles/pulmonary-venous-engorgement">pulmonary venous engorgement</a> / pulmonary blood flow distribution / <a href="/articles/upper-lobe-pulmonary-venous-diversion">upper lobe pulmonary venous diversion</a>-</li>-</ul><p>Some of these features can vary depending on the cause and is best addressed on individual articles <sup>1</sup>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>- +</ul><p>Some of these features can vary depending on the cause and is best addressed on individual articles <sup>1</sup>. There is general progression of signs of CXR that occur as pulmonary capillary wedge pressure (PCWP) increases, as discuss in <a href="/articles/pulmonary-oedema-grading">pulmonary oedema grading.</a></p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>
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