CTICasesFluid Overload-Induced Pulmonary Edema (Pseudo-ARDS)
Imaging findings
Serial chest radiographs in a patient admitted to the neuro ICU for seizures show rapid onset of bilateral, symmetric basilar consolidation and interstitial markings. CT and radiographs demonstrate marked distension of the azygos vein and superior vena cava (suggesting elevated central venous pressure), bilateral pleural effusions, peri-bronchial cuffing, and chest wall subcutaneous edema (anasarca). All findings resolve rapidly within 24 hours of pleural drainage and fluid restriction.
Key takeaways
A significant proportion of ICU patients labeled as having acute respiratory distress syndrome (ARDS) actually suffer from fluid overload and hydrostatic pulmonary edema (pseudo-ARDS). On radiographs, pseudo-ARDS can be distinguished from true acute lung injury by signs of systemic volume overload: azygos vein and SVC dilatation, pleural effusions, and subcutaneous chest wall edema, which rapidly clear with diuresis or fluid restriction.
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