Hydrostatic interstitial pulmonary edema is manifest by perihilar or lower lobe blurring of vascular detail and thickening of the bronchial walls, and eventually septal lines, pleural effusions, and air bronchograms as alveolar flooding with edema fluid occurs. Often hydrostatic edema is accompanied by an increase in the pulmonary vascular volume, as manifest by increased size and peripheral appearance of pulmonary arteries and veins. The central circulating vascular volume may be estimated by the vascular pedicle width and the prominence of the right heart, azygos vein, and superior vena caval shadows, and is often increased in hydrostatic edema ( £19.. 3). The appearance of the chest radiograph characteristically precedes and recovery afterwards postdates the clinical manifestations of hydrostatic edema. Changes in systemic interstitial fluid may be monitored by comparing the width of the soft tissues of the chest wall on serial radiographs.
Fig. 3 Hydrostatic pulmonary edema. This patient had renal failure and central vascular volume overload. The heart and vascular pedicle are increased, with a predominantly perihilar pattern of parenchymal opacification, bronchial cuffing, and vascular indistinctness. Notice the prominent septal (Kerley) lines (white arrowheads on the right and black arrowheads on the left).
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