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).