Presentation
Presented with shortness of breath
Patient Data
![](https://prod-images-static.radiopaedia.org/images/28774303/01e1b6e92b48ade7f125d8ddac9b99_big_gallery.jpeg)
Suboptimal image as left costophrenic angle is not included in the film.
Pacemaker device noted in the left hemithorax with one electrode in place.
Both lungs are congested with upper lobe pulmonary venous diversion, prominent interstitial lung markings and multiple kerley B lines.
Increased cardiothoracic ratio.
Right costophrenic angle is clear.
No pneumothorax.
Findings are suggestive of cardiogenic interstitial pulmonary edema.
Case Discussion
Pulmonary edema is graded depending on chest x-ray and pulmonary capillary wedge pressure (PCWP) is as follows:
grade 0: normal chest radiograph, PCWP 8-12 mmHg
grade 1: upper lobe diversion on a chest radiograph, PCWP 13-18 mmHg
grade 2: interstitial edema on a chest radiograph, PCWP 19-25 mmHg
grade 3: alveolar edema on a chest radiograph, PCWP >25 mmHg
Our case is representing grade 2 pulmonary edema.