CTICasesPulmonary Edema showing the Interlobular Gradient Sign
Imaging findings
CT chest shows peribronchial cuffing, septal thickening, pleural effusions, and ground-glass opacities that pool dependently within the secondary lobules and against the major fissure (interlobular gradient sign), which cleared completely within 24 hours of diuretic therapy.
Key takeaways
Hydrostatic pulmonary edema is a dynamic process. Fluid pools gravitationally (the 'wet sponge' effect) on both a macroscopic scale (against fissures and in dependent zones) and a microscopic scale (dependent portion of the secondary lobule, creating the interlobular gradient sign). This rapid mobility helps distinguish edema from viscous processes like DAD or pneumonia.
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