CTICasesHyperperfusion Pulmonary Edema
Imaging findings
Chest radiograph and CT show a stark contrast between a completely hyperlucent, black right lung and a wet, edematous left lung. CT shows a massive, occluding thromboembolism of the right main pulmonary artery (Palo sign), with marked vessel pruning on the right. In contrast, the left pulmonary vessels are dilated and full, and there is extensive left-sided interstitial edema and septal thickening.
Key takeaways
Unilateral pulmonary edema can occur in the setting of severe, chronic, or acute asymmetric pulmonary artery occlusion (such as from a large pulmonary embolus or congenital hypoplasia). The entire cardiac output is forced into the patent contralateral lung (hyperperfusion/over-circulation). This markedly elevates capillary hydrostatic pressure on the patent side, causing unilateral edema, while the occluded side is protected.
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