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Severe Pulmonary Edema with Venous Lakes

Imaging findings

CT chest shows extensive ground-glass opacities, bilateral pleural effusions, peribronchial cuffing, and irregular, sausage-like or undulating thickening of the interlobular septa (venous lakes/septal pearls) in a patient with acute congestive heart failure and atrial fibrillation.

Key takeaways

Pulmonary edema can manifest as nodular, undulating, or beaded interlobular septal thickening rather than smooth lines, representing dilated pulmonary lymphatics and venules (sometimes called venous lakes or lymphatic pearls). Congested, boggy mediastinal lymphadenopathy is also a common associated finding.

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