Pulmonary Edema

Hydrostatic pulmonary edema is defined as abnormal water in the lungs secondary to

elevated pulmonary venous pressure from a failing left ventricle, mitral stenosis, increased
circulating blood volume (as with anemias), renal failure (causing fluid retention), or
overhydration. Interstitial edema is seen on chest radiographs and CT scans as blurring of the
margins of the blood vessels and bronchial walls (peribronchial cuffing), thickening of the
fissures (subpleural edema), and thickening of the interlobular septae (Kerley lines) (Fig. 37). As capillary pressure rises and interstitial pressure increases, water is forced into the
alveolar spaces through the alveolarcapillary membrane; therefore edema is often seen as
a combination of both interstitial and alveolar opacities on the chest radiograph. The chest
radiograph may also show associated findings of cardiomegaly, pleural effusions, widening of
the vascular pedicle, enlargement of the azygos vein, and vascular redistribution (Fig. 3-8).
Pulmonary edema is so common, relative to other causes of ILD, that it should often be
considered the most likely diagnosis in the differential diagnosis of ILD. An uncommon
pattern of edema is more common than an uncommon cause
P.38
of ILD. Uncommon patterns of pulmonary edema can result from patient positioning or
underlying perfusion abnormalities in the nonedematous lung (e.g., secondary to pulmonary
embolism or asymmetric emphysema). Pulmonary edema can be caused by a number of
processes other than chronic heart failure, and it may present with a normal-sized heart (Table
3-4).