Clinical and radiologic features of pulmonary edema

Pulmonary edema may be classified as increased hydrostatic pressure edema, permeability edema with diffuse alveolar damage (DAD), permeability edema w ithout DAD, or mixed edema. Pulmonary edema has variable manifestations. Po stobstructive pulmonary edema typically manifests radiologically as septal lines, peribronchial cuffing, and, in more severe cases, central alveolar e dema. Pulmonary edema with chronic pulmonary embolism manifests as sharply demarcated areas of increased ground-glass attenuation, Pulmonary edema wit h veno-occlusive disease manifests as large pulmonary arteries, diffuse int erstitial edema with numerous Kerley Lines, peribronchial cuffing, and a di lated right ventricle, Stage 1 near drowning pulmonary edema manifests as K erley lines, peribronchial cuffing, and patchy, perihilar alveolar areas of airspace consolidation; stage 2 and 3 lesions are radiologically nonspecif ic, Pulmonary edema following administration of cytokines demonstrates bila teral, symmetric interstitial edema with thickened septal lines. High-altit ude pulmonary edema usually manifests as central interstitial edema associa ted with peribronchial cuffing, ill-defined vessels, and patchy airspace co nsolidation. Neurogenic pulmonary edema manifests as bilateral, rather homo geneous airspace consolidations that I predominate at the apices in about 5 0% of cases. Reperfusion pulmonary edema usually demonstrates heterogeneous airspace consolidations that predominate in the areas distal to the recana lized vessels. Postreduction pulmonary edema manifests as mild airspace con solidation involving the ipsilateral lung, whereas pulmonary edema due to a ir embolism initially demonstrates interstitial edema followed by bilateral , peripheral alveolar areas of increased opacity that predominate at the lu ng bases. Familiarity with the spectrum of radiologic findings in pulmonary edema from various causes will often help narrow the differential diagnosi s.