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VOL. 98, No.

ACUTE INTERSTITIAL PULMONARY EDEMA

By . F ROBERT HEITZMAN, M.D., and FRED M. ZITER, JR., M.D.

SYRACUSE, NEW YORK

THE pathologic division of pulmonary edema haze. In addition, a diffuse reticular pattern may
into intra-alveolar and interstitial types is well be seen at times (Fig. 1 through 8).
established.16 These two types may occur
separately but more commonly occur in A lines are linear, centrally placed, fine dense
combination. The roentgen pattern produced by lines, up to 4 cm. in length most frequently seen
the intra-alveolar accumulation of fluid is well in the upper lobes directed toward the hilus.
known, although the mechanisms producing its Their pathologic origin and their site of
occasional peculiar batswing or unilateral predilection are variously interpreted.Grainger8
distribution are not clear.1,2,3,17 On the other believes that they are due to edematous septal
hand, interstitial pulmonary edema is less often plates beetwen pulmonary lobules. Trapnell25
recognized, despite its common occurrence. Its suggest that they represent markedly distended
roentgenographic appearance is quite different anasomic lymphatic channels beetwen the hilus
from its alveolar counterpart. The accumulation and pleura, accompanied by perilymphatic
of edema fluid in the connective tissue edema. A lines are known to develop
framework of the lung is most often associated secondary to pneumoconiosis,23 sarcoidosis,24
with mitral stenosis but may also be seen in and malignant cell invasion.20 A Lines have
long-standing left heart failure from any been reported in acute interstitial pulmonary
cause.11. edema20 and were seen almost universa y in Rur
patients with this condition. Although A lines
The acute form of interstitial pulmonary edema do occur from other causes, their very high
is rarely mentioned in the literature.8,14 Since it incidence in acute interstitial edema should,
characteristically produces no auscultatory when they are present, make this diagnosis the
findings,8 the correct clinical diagnosis is paramount consideration.
frequently a difficult one. Consequently,
Aacurateevaluation of the chest roentgenogram Kerleys B lines are fine, dense parallellines,
is often the only means of diagnosis. The 1,5 to 2 cm. in length, most frequently seen in
purpose of the authors is to summarize the lateral portion of the lung bases. Pathologically
salient roentgenologic features of this entity, to they have been shown to represent thickened
differentiate it from alveolar pulmonary interlobular septa.7 The thickening may be due
processes and to emphasize the high frequency to fibrosis, pigment deposition or to deposits of
of its occurrence. abnormal cells as in sarcoidosis or malignancy.
In most instances, the finding is transient and,
ROENTGEN FINDINGS therefore, probably due to edema fluid. Another
roentgen manifestation of interstitial edema is
The roentgenographic features of interstitial the apparent thickening of the pleura, especially
pulmonary edema have been concisely outlined in the interlobar fissures. This is actually due to
by Grainger8 as follows: (1) A and B lines subpleural edema, which extends in continuity
of Kerley ; (2) sub pleural edema ; and (3) hilar from the subpleural interlobular septa and is
*From the Department of Radiology, Upstate Medical Center, Syracuse, New York.
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difficult to distinguish from interlobar pleural that this appearance was the result of interstitial
fluid.The term hilar haze has been used to accumulation of fluid around these vessels.
indicate a los of sharp definition of the large Nonetheless, central alveolar edema has
central pulmonary vessels. Short12 postulated produced this finding,

* From the Department of Radiology, Upstate Medical Center, Syracuse, New York.
292
*From the Department of Radiology, Upstate Medical Center, Syracuse, New York.
*From the Department of Radiology, Upstate Medical Center, Syracuse, New York.
*From the Department of Radiology, Upstate Medical Center, Syracuse, New York.
*From the Department of Radiology, Upstate Medical Center, Syracuse, New York.
*From the Department of Radiology, Upstate Medical Center, Syracuse, New York.

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