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Chest X-Ray
 
 

Pulmonary Oedema

 
 
 
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Overview

  • Signs of Pulmonary Oedema on Chest X-Ray

  • Bat-wing appearance - opacities extending laterally in a fan shape from each hilum
  • Kerley A lines - 5-10cm lines extending from the hila to the periphery (fluid in the deep septa)
  • Kerley B lines - 1.5-2cm lines seen in the periphery of the lower lung extending into the pleura (interlobular septal thickening)
  • Air bronchograms - tubular outlines of the smaller airways
  • Upper lobe diversion (cephalisation) - enlarged upper lobe vessels and smaller lower lobe vessels
  • Associated cardiomegaly (cardiogenic)
  • Causes of Pulmonary Oedema

  • Cardiogenic

  • Heart failure
  • Fluid overload
  • Renal failure
  • Transfusion-associated circulatory overload (TACO)
  • Non-Cardiogenic

  • Acute respiratory distress syndrome
  • Pulmonary embolism
  • Re-expansion pulmonary oedema (e.g. with drainage of a pleural effusion or pneumothorax)
  • Neurogenic pulmonary oedema
  • Transfusion-related acute lung injury (TRALI)
  • High altitude pulmonary oedema (HAPE)
  • Examples

  • Perihilar opacification and increased interstitial markings in keeping with early pulmonary oedema
  • Perihilar opacification and increased interstitial markings in keeping with early pulmonary oedema
     
  • Upper lobe venous diversion
  • Upper lobe venous diversion
     
  • Batwing opacities consistent with acute pulmonary oedema
  • Batwing opacities consistent with acute pulmonary oedema
     
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