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Acute pulmonary edema

Case contributed by Frank Gaillard
Diagnosis almost certain


Acute onset breathlessness.

Patient Data

Gender: Male

Alveolar and interstitial edema.

Annotated image

Annotated alveolar edema (white arrows) and interstitial edema (black arrowheads).

Case Discussion

This patient presented with acute onset of dyspnea. The frontal chest radiograph is the key to diagnosis of acute pulmonary edema.

It shows evidence of both interstitial and alveolar edema. Alveolar edema manifests as ill-defined nodular opacities tending to confluence (see image with arrows). Interstitial edema can be seen as peripheral septal lines - Kerley B lines (arrowheads).

Peripheral septal lines are due to thickening of the interlobular septa. They are 1-3 cm long and extend to the pleural surface. They may be due to pulmonary venous hypertension, as in this case. Other causes are: lymphangitis carcinomatosis; pneumoconioses; sarcoidosis; and pulmonary lymphoma.

Image contributed by: Dr Laughlin Dawes

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