Acute pulmonary edema

Case contributed by Assoc Prof Frank Gaillard

Presentation

Atrial fibrillation and shortness of breath.

Patient Data

Age: 80 years
Gender: Male

Single lead permanent pacemaker (PPM) in situ. The heart is enlarged and there is marked prominence of the interstitial lines. Minimal blunting of the left costophrenic angle. 

Kerley A lines (orange arrows), Kerley B lines (blue arrows) and Kerley C lines (green arrows) are all seen, and all represent essentially the same thing; expansion of the interstitial space by fluid. 

Chest x-ray 10 days earlier

Single lead permanent pacemaker (PPM) in situ. Heart is enlarged, and there is some prominence of the pulmonary vasculature, without evidence of interstitial or alveolar edema. 

Case Discussion

These two films demonstrate the classic appearances of acute interstitial edema, and show how quickly this condition can develop. 

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