CTICasesAsymmetric Pulmonary Edema in a Lung Transplant Recipient with Emphysema (Pseudo-PE Phenomenon)
Imaging findings
Chest CT in a patient with a left single lung transplant and severe native right lung emphysema demonstrates unilateral interstitial edema confined almost entirely to the transplanted left lung, with Kerley B lines, peri-bronchial cuffing, sub-fissural edema, and left pleural effusion. The right emphysematous lung is relatively spared. CT angiography from an outside institution demonstrates apparent filling defects in right pulmonary arteries representing flow-related pseudo-emboli and contrast-unenhanced blood (smoke) due to absent venous return from the emphysematous right lung.
Key takeaways
Pulmonary edema distributes only to lung tissue with intact capillaries; in severe emphysema, the cystic destroyed parenchyma has lost its capillary bed and does not develop edema. This produces asymmetric or heterogeneous lung edema patterns that can mimic fibrotic lung disease. Additionally, severely obstructed high-resistance emphysematous lung causes extremely slow pulmonary artery blood flow, generating unenhanced blood (smoke) in ipsilateral pulmonary arteries that closely mimics pulmonary embolism on CT angiography.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Renal Osteodystrophy — Rugger Jersey SignMetabolic
- Erdheim-Chester Disease with Peri-Renal and Mediastinal InfiltrationNeoplastic
- Left Subpulmonic Pleural Effusion — Stomach-to-Diaphragm Distance SignOther
- Calcified Fibrin Sheath from Central Venous CatheterIatrogenic
- Pulmonary Vein Occlusion after Pulmonary Vein Ablation with Pseudo-PE PhenomenonIatrogenic
- Salmonella Mycotic Aortic PseudoaneurysmInfection
- Sarcoidosis — Subcarinal and Bilateral Hilar Lymphadenopathy with Upper Lobe Micro-NodulesInflammatory
- Small Cell Carcinoma Presenting with Bulky Mediastinal LymphadenopathyNeoplastic
See all cases from February 4, 2021 →