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Dependent Hydrostatic Pulmonary Edema

Imaging findings

CT chest shows symmetric, gravity-dependent ground-glass opacities in the posterior lung zones, with a striking absence of interlobular septal thickening or pleural effusions. The patient was in hypervolemic fluid overload.

Key takeaways

Hydrostatic pulmonary edema can occasionally manifest purely as dependent alveolar ground-glass opacities with complete sparing of the bronchovascular bundles and septa. This gradient of fluid accumulation can mimic infectious processes (like COVID-19 pneumonia) on CT, necessitating clinical correlation with fluid status.

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