Case 1019
Cardiogenic pulmonary edemaWhat is the diagnosis?
Answer hidden. Review the images and history, decide on your diagnosis, then reveal.
Findings
- Bilateral perihilar airspace shadowing
- Indistinct, enlarged hilar vessels and interstitial lines
- Enlarged cardiac silhouette and blunted costophrenic angles in keeping with effusions
Case discussion
Bilateral perihilar opacities with cardiomegaly and effusions in a breathless patient with fluid overload point to cardiogenic pulmonary edema.
The radiographic signs progress with rising left atrial pressure: upper lobe venous diversion, then interstitial edema (Kerley B lines, peribronchial cuffing), then alveolar edema. Treat the edema and look for the trigger, such as ischaemia, arrhythmia or valve disease.
