CTICasesAsymmetric Pulmonary Edema with Septal and Lymphatic Congestion Mimicking Infection
Imaging findings
The same patient later returned neutropenic and febrile with a nonspecific area of right-upper-lobe consolidation that, over just six days, rapidly evolved into extensive lobar consolidation with bilateral small effusions and prominent interlobular septal thickening described as venous lakes and lymphatic pearls. Bronchoscopy grew Aspergillus, but the pulmonary veins were patent and uncompromised, and the abnormality improved substantially within about a week on antifungals and diuresis.
Key takeaways
Rapidly evolving lobar consolidation with septal thickening and small effusions in a neutropenic patient can reflect asymmetric pulmonary edema and lymphatic congestion, from adjacent inflammation obstructing lymphatics, rather than pure progressive infection, particularly when the pulmonary veins are patent and the abnormality resolves rapidly with diuresis. A positive culture such as Aspergillus does not preclude a coexisting vascular or lymphatic congestive component driving much of the imaging appearance.
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