Pulmonary Interstitial OedemaCreated OnMay 4, 2020Last Updated OnMay 5, 2020byadmin You are here: Main Radiology Pulmonary Interstitial Oedema < All Topics Table of Contents Pulmonary Interstitial Oedema Four signs of pulmonary interstitial oedema Kerley B lines Peribronchial cuffing/thickening – wall is normally hairline thin Thickening of the fissures – Fluid in subpleural space in continuity with interlobular septa Pleural effusions. Septal lines (Kerley B lines) Horizontal lines at the edge of the lungs They are actually thickened interlobular septa at the peripheries of the lungs. It is one of the sign indicating interstitial oedema in the context of suspected left ventricular failure The airspace shadowing is indicative of pulmonary alveolar oedema. Pulmonary Alveolar Oedema Fluffy, indistinct patchy densities Outer 3rd of lung usually spared Hence, causing batwing/butterfly Perihilar haziness and/or consolidation Bat’s wing pattern Alveolar oedema manifests as airspace shadowing (consolidation) Fluid from interstitial tissues leaks into the alveoli and small airways symmetrically from the hilar regions, forming a ‘bat’s wing’ distribution. Note the clues suggestive of heart problem – Cardiomegaly(CTR 60%) and cardiac surgery artifact. Interstitial fluid leaking to pleural space can also cause pleural effusion evidenced by blunting of bilateral costophrenic angle. Non-cardiogenic Pulmonary Oedema Features Diffuse bilateral airspace disease More peripheral than central distribution Heart size is normal Usually no Kerley B lines, peribronchial thickening, pleural effusions. Causes Adult respiratory distress syndrome (ARDS) Neurogenic oedema High altitude oedema Heroine, cocaine overdose Allergic reaction Inhalational injury Near-drowning This is a nephrotic syndrome patient with pulmonary oedema – due to low albumin Note that the normal heart size (CTR <50%) If the heart size is normal, then heart disease may still be the cause of pulmonary oedema, but non-cardiogenic causes should also be considered The converse is also true – if the heart is enlarged, then the cause of pulmonary oedema is not always cardiac Cardiogenic VS non-cardiogenic Pulmonary Oedema Cardiogenic Non-cardiogenic Cardiomegaly Yes Rare Interstitial thickening Yes – Kerley lines Rare Pleural effusion Yes Rare Consolidation Central, perihilar, “Batwing” Peripheral *Some of the image photo is taken from web, we do not own this, it’s for knowledge sharing purpose.
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