An abnormal extravascular accumulation of fluid in the lungs, often secondary to elevated hydrostatic pressure or increased capillary permeability (Radiopaedia).

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Here’s a comprehensive radiology reference-style overview of pulmonary edema, emphasizing its imaging characteristics on chest X-ray and CT:

🧠 What is Pulmonary Edema?

An abnormal extravascular accumulation of fluid in the lungs, often secondary to elevated hydrostatic pressure or increased capillary permeability (Radiopaedia).

Types & Causes

  • Cardiogenic (hydrostatic) edema: due to heart failure, valvular dysfunction, volume overload .

  • Non-cardiogenic (permeability) edema: from ARDS, toxins, negative pressure events, fluid overload (Radiopaedia).

  • Mixed: combinations of both mechanisms (Radiopaedia).

📸 Chest X‑Ray (CXR) Findings

  1. Early (Interstitial) signs:

    • Vascular redistribution: upper-lobe vessel prominence (“cephalisation”) (PMC, Radiopaedia).

    • Interstitial thickening:

      • Peribronchial cuffing – fluid rounds bronchial walls (Radiopaedia).

      • Kerley B lines – septal thickening .

      • Fissure blurring and pleural effusions .

  2. Later (Alveolar) signs:

    • Alveolar “bat-wing” or perihilar opacities, often bilateral (Radiopaedia).

    • Air bronchograms: air-filled bronchi visible within fluid-filled alveoli (Wikipedia).

  3. Supportive indicators: cardiomegaly, widened vascular pedicle, pleural effusion (PMC).

🖥️ CT Features

  • Ground-glass opacities: hazy increased lung attenuation .

  • Interlobular septal thickening: smooth, fluid-filled septa (Radiopaedia).

  • Bronchovascular bundle thickening (Radiopaedia).

  • Consolidations in alveolar edema (Radiopaedia).

  • Pleural effusions common in cardiogenic edema (Radiopaedia).

  • Quantitative CT using Hounsfield unit thresholds (-825 HU in upper lobes) shows high accuracy for edema detection (PMC).

⚙️ Ultrasound

  • Lung ultrasound reveals B-lines, characteristic of interstitial-alveolar syndrome (Wikipedia).

✅ Differential Diagnosis

  • Cardiogenic: look for cephalisation, septal lines, cardiomegaly.

  • Non-cardiogenic: more patchy distributions, normal heart size, ARDS pattern (Radiopaedia).

  • Unilateral edema: may mimic pneumonia; CT helps clarify (Verywell Health).

🔄 Typical Imaging Progression

  1. Vascular redistribution → 2. Interstitial signs → 3. Alveolar consolidation .

📝 Key Takeaways for Radiologists

  • Identify vascular and interstitial changes early on CXR.

  • Confirm with CT: ground-glass, septal thickening, consolidation.

  • Consider ultrasound for bedside assessment in unstable patients.

  • Use quantitative CT metrics for objective diagnosis where available.

This structured, clinically oriented overview is ideal for a radiology reference article. You might enhance it with:

  • Annotated images (e.g., highlighting Kerley B lines, bat-wing pattern).

  • A flowchart linking imaging patterns to likely etiologies (cardiogenic vs non-cardiogenic).

  • A grading table comparing severity across modalities: CXR vs CT vs ultrasound.

Let me know if you'd like help with image annotation, template formatting, or other enhancements!

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