Pediatric Pulmonary Edema

Etiology:
— Cardiogenic – Left heart failure (congestive heart failure), rheumatic heart disease causing mitral valve disease, aortic stenosis, arrthymias, myocardial disease such as myocarditis or cardiomyopathy
— Non cardiogenic – Acute asthma, near drowning, acute glomerulonephritis, hemolytic uremic syndrome, adult respiratory distress syndrome, negative pressure with forced inspiration against an obstructed airway due to laryngospasm during anesthesia, aspirin overdose
Imaging CXR: Perihilar infiltrates with butterfly wing distribution
DDX:
Complications:
Treatment:
Clinical:

Radiology Cases of Pulmonary Edema

Radiology Cases of Cardiogenic Pulmonary Edema

Radiology Cases of Expiratory Chest Mimicking Cardiogenic Pulmonary Edema

Difference between pediatric inspiratory and expiratory CXR — Inspiratory CXR (above) shows well expanded lungs, normal heart size, and normal appearing pulmonary vasculature. Expiratory CXR in the same patient (below) shows poorly expanded lungs, cardiomegaly, and prominent pulmonary vasculature.

Inspiratory and expiratory CXR — Inspiratory CXR (above) shows well expanded lungs, normal heart size, and normal appearing pulmonary vasculature. Expiratory CXR in the same patient (below) shows poorly expanded lungs, cardiomegaly, and prominent pulmonary vasculature.

Normal inspiratory and expiratory CXR — Initial CXR AP (left) shows the heart to be enlarged and the pulmonary vascularity to be congested and there are low lung volumes. Repeat CXR AP obtained 5 minutes later in inspiration (right) shows the heart to be normal in size and the pulmonary vascularity is not congested and there are normal lung volumes.

Radiology Cases of Cardiogenic Pulmonary Edema in Rheumatic Heart Disease

CXR of pulmonary edema due to mitral insufficiency in rheumatic heart disease — CXR AP shows cardiomegaly and bilateral perihilar interstitial infiltrates.

Radiology Cases of Cardiogenic Pulmonary Edema in Paroxysmal Atrial Tachycardia

CXR of pulmonary edema in paroxysmal atrial tachycardia — CXR AP shows mild cardiomegaly and bilateral perihilar interstitial infiltrates due to pulmonary vascular congestion.

Radiology Cases of Cardiogenic Pulmonary Edema in Supraventricular Tachycardia

CXR of tachyarrythmia cardiomyopathy — CXR AP shows increased pulmonary vascularity and mild cardiomegaly.

CXR of supraventricular tachycardia — CXR AP shows mild cardiomegaly with bilateral perihilar lung opacities with a batwing appearance.

Radiology Cases of Non-Cardiogenic Pulmonary Edema

Radiology Cases of Non-Cardiogenic Pulmonary Edema in Acute Glomerulonephritis

CXR of pulmonary edema in acute glomerulonephritis — CXR PA and lateral shows cardiomegaly and bilateral perihilar interstitial infiltrates along with blunting of the costophrenic angles due to small bilateral pleural effusions best seen on the lateral.

Radiology Cases of Non-Cardiogenic Pulmonary Edema in Near Drowning

CXR of pulmonary edema from near drowning — CXR AP shows bilateral dense confluent infiltrates throughout the lungs.

CXR of non-cardiogenic pulmonary edema due to near drowning — CXR AP shows bilateral perihilar infiltrates in a butterfly wing distribution.

CXR of pulmonary edema in near drowning — CXR AP shows a normal sized heart and bilateral perihilar interstitial infiltrates. There is also a dense opacity in the right upper lobe.

Radiology Cases of Non-Cardiogenic Pulmonary Edema in Asthma

CXR of cardiogenic pulmonary edema in asthma — CXR AP (left) shows cardiomegaly and bilateral perihilar interstitial infiltrates due to pulmonary vascular congestion. CXR AP (right) obtained after resolution of symptoms shows the heart and pulmonary vascularity to be normal in appearance while the airways are thickened and the lungs are hyperexpanded.