CTICasesHydrostatic (Interstitial) Pulmonary Edema
Imaging findings
CT obtained after a chest radiograph and CT pulmonary angiogram in an emergency department patient shows numerous, unusually thick septal lines predominantly in the lower lungs, edema tracking within the interlobular septa, and thickened bronchovascular connective tissue sheaths surrounding the bronchi and pulmonary arteries with resultant narrowing of the airways. Subpleural interstitial edema is well seen along the interlobar fissures on the lateral projection, and mediastinal windows show fluid tracking along the bronchovascular sheaths into the mediastinum with waterlogged-appearing lymph nodes.
Key takeaways
This case is a comprehensive teaching example of hydrostatic interstitial pulmonary edema, demonstrating how fluid in the peribronchovascular connective tissue sheath can compress the adjacent bronchi and produce airway narrowing, the CT correlate of clinical cardiac asthma wheezing in patients with heart failure. Recognizing the pattern of septal thickening, subpleural and peribronchovascular edema, and nodal waterlogging helps distinguish hydrostatic edema from other causes of septal thickening.
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