IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Cardiogenic pulmonary edema (ultrasound)

Case contributed by David Carroll
Diagnosis almost certain

Presentation

Progressive dyspnea on exertion.

Patient Data

Age: 55 years
Gender: Male

Lungs: sliding present bilaterally, visceral-parietal pleural interface regular, symmetric and innumerable B-lines anteriorly.

Parasternal long axis: septum/posteroinferior wall severely hypokinetic, wall thickening markedly reduced, E-point septal separation >2cm (normal <7mm), no apparent pericardial fluid.

Subcostal vena cava: junction with right atrium visualized in long axis, IVC plethoric with minimal respirophasic variability, hepatic veins distended.

Case Discussion

Point‐of‐care echocardiography is often integrated into the emergency evaluation of undifferentiated presentations suspected to have a cardiopulmonary etiology5

Designed to assess the presence or absence of common hemodynamic patterns encountered in the critically ill, a limited examination of the lungs often serves as a surrogate for left atrial pressure if signs of elevated filling pressures are present. Assessment of the IVC serves as a rough correlate of RAP.2

Presenting with progressive dyspnea on exertion, the patient in question was examined with the following questions:

  • what is the global (qualitative) left ventricular function?
  • is there any obvious pathology e.g. effusion, septal bowing, dissection flap?
  • what are the chamber dimensions and wall thickness?

In this context (clinical suspicion for CHF), the findings of depressed wall movement and thickening, chamber dilation, extravascular lung water, and a dilated IVC are consistent with the presence of poor forward flow, cardiac remodeling, elevated pulmonary venous and capillary pressures, and volume overload,6 defining features of the heart failure syndrome (with prominent systolic dysfunction). Myocardial stiffness and relaxation are more laborious to approximate; with a preserved ejection fraction but findings consistent with heart failure, point of care echocardiography protocols often use increased wall thickness as supporting evidence of "diastolic'' dysfunction.6

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.