CTICasesDependent Alveolar Edema in Acute Heart Failure
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Imaging findings
Striking dependent consolidation, almost an air-fluid level in the lungs, with improvement over a few days. Other signs include interstitial septal thickening, visceral thickening, and patchy bronchocentric opacities. Physiologically, there was slow transit of contrast into the left heart, a contrast fluid level in the IVC, and contrast layering in hepatic veins. The patient had no history of witnessed aspiration and was afebrile.
Key takeaways
It is important to differentiate dependent alveolar edema in acute heart failure from pneumonia or aspiration, especially when consolidation is striking and dependent. Airspace edema is more mobile than interstitial edema and may redistribute over time. Look for other signs of heart failure such as slow contrast transit and contrast layering in the IVC and hepatic veins to support the diagnosis.
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