Infiltrates in nephrogenic pulmonary edema are classically described as having a bat-wing distribution, whereas those in lung injury tend to be more peripheral. Another feature that may be seen is cardiac enlargement, in cases of previous cardiac failure. Although the peripheral infiltrate is fairly specific for lung injury, the diffuse variety is seen with equal frequency in lung injury. [11]. Stark and colleagues described the CT scan features of 28 patients with ARDS. [8] They identified 3 principal and 7 ancillary features; all of these were statistically significant and, in a large percentage of cases, allowed accurate determination of the cause of edema. Whether the hemodynamic changes produce a pulmonary capillary leak through pressure-induced mechanical injury to the pulmonary capillaries or whether some direct nervous system control over pulmonary capillary permeability exists remains uncertain. Diagnostic value of the portable chest x-ray technic in pulmonary edema. A case of non-car-diogenic acute pulmonary edema in a patient with poems syndrome-associated pulmonary arterial hypertension. All but one of the patients were mechanically ventilated. [Medline]. O'Donovan PB. [Full Text]. 2017 Jul. Cardiogenic edema pathogenically is caused by elevated hydrostatic pressure in the pulmonary capillaries due to left sided congestive heart failure. Jeffrey A Miller, MD Associate Adjunct Professor of Clinical Radiology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Faculty, Department of Radiology, Veterans Affairs of New Jersey Health Care System Overall accuracy of diagnosis in the Milne study was in the range of 86-89%. 1994 May. The infiltrates of cardiogenic pulmonary edema are usually diffuse, and air bronchograms are rare. For clinical purposes, pulmonary oedema is grossly divided based on pathophysiology into cardiogenic and non-cardiogenic oedema. [20, 21]. 1978 Apr. As the edema progresses, alveolar edema is observed in a butterfly pattern characterized by the central predominance of shadows, with a clear zone at periphery lobes. The latter, noncardiogenic pulmonary edema (NPE), is caused by changes in permeability of the pulmonary capillary membrane as a result of either a direct or an indirect pathologic insult (see the images below). 2018:[Medline]. Ram Sundar Kasthuri, MBBS Specialist Registrar, Department of Radiology, North Manchester General Hospital, UKDisclosure: Nothing to disclose. In cardiogenic pulmonary edema, the central therapeutic focus is to decrease preload by aggressive diuresis using loop diuretics. 1996 Mar. Can Respir J. Non-cardiogenic pulmonary edema and life-threatening shock due to calcium channel blocker overdose: a case report and clinical review. [Medline]. Clin Med & Res 2012; 10: 131–136. They found “moderate” interobserver agreement among clinicians in diagnosing ARDS using Berlin's criteria. For example, ultrasonograhy has been used in the assessment of pulmonary edema (PE) in high-altitude missions as well as after apnea diving. Eur Rev Med Pharmacol Sci. Many causes of NPE exist, including drowning, acute glomerulonephritis, fluid overload, aspiration, inhalation injury, neurogenic pulmonary edema, allergic reaction, and adult respiratory distress syndrome (ARDS). [Full Text]. Feletti F, Mucci V, Aliverti A. [18] Patients in the study suffered from respiratory insufficiency and bilateral, alveolar pulmonary edema, as demonstrated on chest radiographs. Non-cardiogenic pulmonary edema is a classification of pulmonary edema where the underlying etiology is not due to left ventricular dysfunction. A mixed picture with varying levels of the viral pneumonia and non-cardiogenic pulmonary oedema. 5 article feature images from this case 23 public playlist includes this case Pulmonary oedema can be cardiogenic (high pressure) or non-cardiogenic (increased vascular permeability). Conventional chest radiographs are universally available. [17]. Although several episodes of NPE resolve spontaneously, the condition may cause unexpected death among patients with epilepsy. [16], Echocardiography may also play a role in the differentiation of cardiogenic pulmonary edema from NPE. Pulmonary edema is frequently classified as hydrostatic edema (e.g., cardiogenic pulmonary edema) or edema caused by increased capillary permeability (e.g., noncardiogenic pulmonary edema or capillary leak). [free full text] O’Leary R, McKinlay J. Neurogenic pulmonary oedema. Gattinoni and coauthors examined 10 patients with full-blown ARDS who were receiving mechanical ventilation with positive end-expiratory pressure (PEEP) and who underwent lung CT scanning. 135(4):604-6. Lung transplantation: indications, donor and recipient selection, and imaging of complications. [5, 6] Herman and colleagues, however, found chest radiography to be helpful, but not definitive, in distinguishing problems after bilateral lung transplantation and found CT scanning to be excellent for the demonstration of airway problems. Histologically, ARDS is characterized by diffuse alveolar damage (DAD) and extravasation of protein-rich edema (Figure 1) with frequent evolution to pulmonary fibrosis. Following the intravenous administration of steroids, radiographic resolution occurred in 4 cases. 2015:150014. 1989 Dec. 153(6):1181-5. Klaus L Irion, MD, PhD Consulting Staff, The Cardiothoracic Centre Liverpool NHS Trust, The Royal Liverpool University Hospital, UK