Noncardiogenic Pulmonary Edema



Noncardiogenic Pulmonary Edema


Aliye O. Bricker, MD

Tan-Lucien H. Mohammed, MD, FCCP





Key Facts


Terminology



  • Acute lung injury is 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


  • ARDS commonly defined by ratio of PaO2:FiO2 < 200, whereas ALI PaO2:FiO2 < 300


  • ARDS divided into extrapulmonary and pulmonary causes


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


Imaging Findings



  • Typical pattern: Intense pulmonary opacification 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


  • Survivors develop mild reticular pattern in anterior lung (85%), residual ground-glass opacities (60%), lobular hyperinflation (50%), emphysema (33%)


  • Pleural effusions (50%) (majority > 1 cm thick)


Top Differential Diagnoses



  • Cardiogenic Edema


  • Diffuse Alveolar Hemorrhage


  • Diffuse Pulmonary Infection


Clinical Issues



  • Mortality rate (50%)







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.


TERMINOLOGY


Abbreviations and Synonyms



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


Definitions



  • 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


IMAGING FINDINGS


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

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

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