Interstitial pulmonary oedema

Case contributed by Dr Bruno Di Muzio

Presentation

Chest pain.

Patient Data

Age: 87
Gender: Female
X-ray

Heart size is normal. Generalised prominence of the interstitial markings throughout the lungs. Small 8mm pulmonary nodule projects within the right mid-upper zone. No consolidation or evidence of pulmonary oedema. No pleural effusions. Bilateral high riding humeral heads with extensive degenerative change including of the undersurface of the acromion.

A pulmonary embolus was suspected based on some risk factors. CTPA was requested. 

CT

CT Chest

There is diagnostic contrast opacification of the pulmonary arteries. There is no pulmonary embolus.

Small bilateral pleural effusions and mild posterior basal atelectasis. Minor scar bands in the right lung apex. No focal consolidation.

Bronchial wall thickening within the lower lobes associated with a few peripheral centrilobular nodules and subtle peribronchial ground glass changes, particularly in the upper zones. Subpleural and interlobular septal markings in the lower zones, consistent with Kerley B lines.

There is no lymph node enlargement or other mediastinal abnormality.

Small sclerotic foci with the posterior aspects of the third and sixth ribs on the right, nonspecific, most likely representing enostosis.

Conclusion: No evidence of pulmonary embolism. Bilateral small pleural effusions with peribronchial thickening and interlobular septal thickening/Kerley B lines consistent with interstitial pulmonary oedema, with accompanying subtle peribronchial ground glass and scattered centrilobular nodules, likely reflecting an early mixed airspace component of oedema.

Case Discussion

This patient had a myocardial infarction and the pulmonary oedema is probably related to this clinical scenario. 

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Case information

rID: 44769
Case created: 4th May 2016
Last edited: 23rd Mar 2017
System: Chest
Inclusion in quiz mode: Included

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