Acute pulmonary edema

Case contributed by Frank Gaillard
Diagnosis certain


Atrial fibrillation and shortness of breath.

Patient Data

Age: 80 years
Gender: Male

Chest x-ray


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 lines

Annotated image

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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