Non-Cardiogenic Pulmonary Edema

by Hetal Verma, MD

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    00:01 So now let's discuss pulmonary edema that's caused by non cardiogenic causes.

    00:05 This is slightly less common than cardiogenic pulmonary edema but it's important to try and differentiate between the two when you do see it.

    00:12 So as we know cardiogenic pulmonary edema is usually caused by CHF and it's because of an increase pulmonary venous pressure.

    00:19 Non cardiogenic edema is usually caused by increased capillary permeability that may or may not be caused by alveolar damage and it usually result in volume overload.

    00:28 So there are multiple different causes of non cardiogenic pulmonary edema just to list some of them, it can be caused by ARDS or adult respiratory distress syndrome.

    00:39 Neurogenic edema can cause it so in a patient that has any kind of brain abnormality, high altitude edema.

    00:45 So patients that are travelling to very high altitudes all of a sudden can cause pulmonary edema.

    00:51 Lymphangitic spread of malignancy can be a cause, any kind of drug overdose especially heroin or cocaine.

    00:58 Re-expansion edema in a patient that has atelectasis that expands very quickly.

    01:04 Any kind of allergic reaction and inhalational injury, aspiration can cause it and patients that undergo near drowning experiences can also have pulmonary edema. So again these are just the few of the many different causes of pulmonary edema that's cause by non cardiogenic origin.

    01:23 So some of the radiographic features overlap with congestive heart failure or cardiogenic edema. It includes bilateral, diffuse airspace disease or the ground glass opacity that we saw with CHF.

    01:36 Usually though with non cardiogenic edema it has a more peripheral distribution rather than a central distribution which is somewhat different than CHF.

    01:44 One important thing to help you differentiate is that the heart size is actually normal and you'd normally don't see Kerley B lines, peribonchial thickening or pleural effusions.

    01:54 However again, there is considerable overlap with cardiogenic edema.

    01:59 So this is an example of pulmonary edema.

    02:03 So can you tell whether this is CHF or whether this is non cardiogenic? It's a little bit difficult actually.

    02:09 So this radiograph demonstrates a patient with the normal heart size which is really the key difference but it does have bilateral, central pulmonary edema and it's a distribution that's similar to cardiogenic edema as we said non cardiogenic is usually more peripheral in distribution.

    02:26 But there are no pleural effusions.

    02:28 So given the fact that the patient has a normal heart and has no pleural effusions, this actually represents non cardiogenic pulmonary edema.

    02:35 This was obtain in a patient that had recent cracked, cocaine use.

    02:39 So the clinical history should also help you.

    02:41 So let's look at the differences between cardiogenic and non cardiogenic.

    02:48 So in cardiogenic pulmonary edema you normally would have cardiomegaly but again you would not or it's very rare to find that in patients that have non cardiogenic edema.

    02:58 Interstitial thickening is seen really only in patients with cardiogenic edema and that's represented as Kerley B lines.

    03:04 You would see pleural effusion, rarely in patients with cardiogenic edema.

    03:09 And consolidation, again is more central and perihilar in patients with cardiogenic edema.

    03:15 Again you would have that classic batwing appearance in patients with cardiogenic edema but in non cardiogenic edema usually the consolidation is seen more peripherally but as we just saw the case that's not always true.

    03:26 So let's take a loot at this case.

    03:30 Do you think this is cardiogenic or non cardiogenic edema? So here are some of the findings. Let's review some these.

    03:46 So the patient does have an enlarged heart, the patient has cephalization or prominence of the pulmonary vascular in the upper lobe as you can see by the arrow and the patient has perihilar haziness which we can see by the circle.

    03:59 So this is actually an example of congestive heart failure or cardiogenic edema and the key features here are the enlarged heart and the cephalization which we really wouldn't expect to see in a patient that has non cardiogenic edema.

    04:12 So we've gone over some of the findings, similarities and differences between cardiogenic and non cardiogenic edema.

    04:18 Again, the clinical history is very important in these cases but there are few imaging findings that you can use to help you differentiate between the two.

    About the Lecture

    The lecture Non-Cardiogenic Pulmonary Edema by Hetal Verma, MD is from the course Thoracic Radiology.

    Included Quiz Questions

    1. Peripheral distribution
    2. Pleural effusion
    3. Kerley B lines
    4. Cardiomegaly
    5. Peribronchial thickening
    1. Increased pulmonary venous pressure
    2. High altitude edema
    3. Lymphatic spread of malignancy
    4. Cocaine abuse
    5. Aspiration
    1. The heart appears enlarged due to pleural effusion.
    2. There is diffuse involvement of bilateral airspace.
    3. There is the absence of Kerley B lines, peribronchial thickening, and pleural effusion.
    4. Adult respiratory distress syndrome can progress to present as non-cardiogenic pulmonary edema.
    5. There is increased capillary permeability with or without diffuse alveolar damage.

    Author of lecture Non-Cardiogenic Pulmonary Edema

     Hetal Verma, MD

    Hetal Verma, MD

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