Chest X-Ray breakdown: a guide to pulmonary oedema

A male in his 70s presents with acute breathlessness. What does this PA chest X-Ray show?

PULMONARY OEDEMA
👨🏽‍💻This is a really important X-Ray diagnosis! Breathlessness is a really common presenting complaint and this symptom accounts for a lot of the chest X-Rays that happen in ED

👨🏽‍💻Knowing the key features of pulmonary oedema is therefore really important as knowing the classic pattern can help us differentiate this from pneumonia

👨🏽‍💻Telling the difference can be very difficult as both can present with consolidation and pleural effusions - looking for other signs such as cardiomegaly (if it is a PA film) and interstitial oedema (such as Kerley B lines - small horizontal lines in the peripheral lower zones) can help sway us one way or the other

👨🏽‍💻Remember not all pulmonary oedema is related to the heart, fluid can accumulate within the extravascular spaces of the lung in other situations which we go through in the video

👨🏽‍💻Bat wing oedema refers to central bilateral consolidation which look like bat wings - this pattern of pulmonary oedema is usually seen in ▫️rapidly developing heart failure such as in acute mitral insufficiency (for example occurring with papillary muscle rupture which can happen in MI)
▫️renal failure

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[michaelt]

Brilliant explanation as always. Invaluable clinical insight thank you 👍🏼

[TheFauCheuse]

Travels to lesser to higher, not higher to lesser 1:24