CT will also demonstrate signs of congestive heart failure.

On the image on the left notice the following:

 Thickened septal lines due to interstitial edema

 Subtle ground glass opacity in the dependent part of the lungs (HU difference of 100-150
between the dependent and non-dependent part of the lung).
 Bilateral pleural fluid.

In a patient with a known malignancy lymphangitic carcinomatosis would be high in the

differential diagnostic list.
Ground glass opacity is the first presentation of alveolar edema and a precursor of consolidation.
Stage III - Alveolar edema
This stage is characterized by continued fluid leakage into the interstitium, which cannot be
compensated by lymphatic drainage.
This eventually leads to fluid leakage in the alveoli (alveolar edema) and to leakage into the
pleural space (pleural effusion).

The distribution of the alveolar edema can be influenced by:

 Gravity: supine or erect position and right or left decubitus position

 Obstructive lung disease, i.e. fluid leakage into the less severe diseased areas of the lung
On the left a patient who was admitted with severe dyspnoe due to acute heart failure.
The following signs indicate heart failure: alveolar edema with perihilar consolidations and air
bronchograms (yellow arrows); pleural fluid (blue arrow); prominent azygos vein and increased
width of the vascular pedicle (red arrow) and an enlarged cardiac silhouette (arrow heads).
After treatment we can still see an enlarged cardiac silhouette, pleural fluid and redistribution of
the pulmonary blood flow, but the edema has resolved.
On the left another patient with alveolar edema at admission, which resolved after treatment.
When you scroll through the images and go back and forth, you will notice the difference in
vascular pedicle width and distribution of pulmonary flow.
Both on the chest x-ray and on the CT the edema is gravity dependent and differences in density
can be measured.