Pulmonary edema

Case contributed by Abeer Ahmed Alhelali

Presentation

Presented with shortness of breath

Patient Data

Age: 60 years
Gender: Male
x_ray

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 diversionon 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.

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