Showing posts with label CHF. Show all posts
Showing posts with label CHF. Show all posts

Monday, September 12, 2011

Cardiac decompensation-CXR

Elderly person with shortness of breath what is the finding?

There is big heart and generally ill-defined lung fields. On closer examination,  we notice, upper lobar vessels are around 3mm(normal maximum of 2mm) called cephalization has occurred. There are few areas of peribronchial cuffing i.e. there is interstitial fluid accumulated around the bronchi  making them look like doughnuts . Both perihilar regions are hazy and ill-defined suggesting fluid. The appearance  is  classical of  cardiac decompensation.

Teaching points by Dr MGK Murthy
·         Left atrial pressure measure is quite represented by X ray appearance. Normal being 5-10 mm Hg, cephalization(10-15),Kerley B lines (15-20),interstitial edema(20-25), an alveolar edema(>25mm Hg)
·         Kerley B lines are 1-2 cms long horizontal bases  lines  and are perpendicular to pleural surface
·         Pulmonary oedema usually clears in about 3days or less. Clearance is usually from periphery to center(because of  emptying effect of breathing and movement )
·         Unilateral oedema may be seen in dependent side if patient lies on one side overnight. Normal vessel to bronchus ratio is upper lobes(0.85), at hila(1.0) and lower lobes (1.35).

Tuesday, February 15, 2011

Pulmonary Edema- CXR

"Early signs of pulmonary edema (intersticial edema) are the Kerley B lines, horizontal lines seen laterally in the lower zones, 2 cm long at last reach the lung edge. As the edema progress alveolar edema is observed with its "butterfly-batwing" pattern, characterized by the central predominance of shadows with a clear zone at periphery lobes. Other feature that may be seen is cardiac enlargement, in case of cardiac failure previously present. A helpful feature in distinguishing cardiac pulmonary edema from non cardiac pulmonary edema and from pneumonia, is the speed with which the edema appears and disappears. Substantial improvement in a 24 hour period is virtually diagnosis of cardiac pulmonary edema. These are two CXR done before and after decongestant therapy. "

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