Noncardiogenic Pulmonary Edema

Noncardiogenic Pulmonary Edema

Aliye O. Bricker, MD

Tan-Lucien H. Mohammed, MD, FCCP

Axial NECT shows dependent consolidation image transitioning to nondependent ground-glass opacities image. Note the barotrauma with pneumomediastinum image.

Axial NECT shows dependent gradient from intense pulmonary opacification image to diffuse ground-glass opacities image.


Abbreviations and Synonyms

  • Noncardiogenic pulmonary edema, increased permeability edema, shock lung, adult respiratory distress syndrome (ARDS), acute lung injury (ALI)


  • Acute lung injury general term for hypoxemic respiratory failure due to alveolar epithelial and capillary endothelial injury

    • ARDS is subset of ALI

    • Acute interstitial pneumonia (AIP) is idiopathic form of ARDS

  • Consensus definition of ALI/ARDS

    • Acute onset of hypoxemic respiratory failure

    • Stiff lung (decreased compliance)

    • Diffuse radiographic infiltration

    • Absence of left atrial hypertension

    • ARDS commonly defined by ratio of PaO2:FIO2 < 200, whereas ALI PaO2:FIO2 < 300

  • ARDS divided into extrapulmonary and pulmonary causes

    • Nearly any medical or surgical condition may result in ARDS

      • Common conditions: Sepsis, pneumonia, trauma, aspiration

  • Diffuse alveolar damage (DAD) is pathologic equivalent of ARDS


General Features

  • Best diagnostic clue: Intubated patient with diffuse bilateral lung disease

  • Patient position/location: Dependent intense pulmonary opacification (IPO) and more nondependent ground-glass opacities (like oil and water in a glass)

CT Findings

  • In contrast to radiographs, strikingly inhomogeneous distribution on CT

  • Following “typical” appearance idealized; in clinical situations wide range of radiographic abnormalities

    • Sensitivity and specificity for diagnosis of ARDS (70%)

    • Typical pattern more common with ARDS from extrapulmonary cause

  • Individual features

    • Ground-glass opacities

    • Intense parenchymal opacification may be due to consolidated lung or compressive atelectasis

    • Individual features nonspecific

      • Do not help differentiate ARDS from pulmonary or extrapulmonary cause or distinguish between other causes of diffuse infiltration

  • Morphology of typical pattern

    • IPO-dependent lung (dorsal lung in supine position)

    • Ground-glass (GG) opacities layered on top of IPO

    • Normal lung (if any) occupies most nondependent lung

    • 3 components: IPO, GG, and air layered like water, oil, and air in a glass

    • Extent of abnormal lung averages 80% of lung volume

    • Distribution gravity dependent and will evolve into same pattern when placed prone (usually within 10-20 minutes)

  • Variation (atypical patterns)

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Sep 20, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on Noncardiogenic Pulmonary Edema
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