Kardiyojenik akciğer ödemi

Özet

Kardiyojenik akciğer ödemi, sol kalp dolum basınçlarının yükselmesiyle interstisyel ve ardından alveoler sıvı birikiminin geliştiği akut ya da kronik konjesyon örüntüsüdür. Kontrastsız toraks BT'de düzgün septal kalınlaşma, bronkovasküler kılıflanma, damar dolgunluğu ve sıklıkla plevral efüzyon birlikte görülebilir; parankim ödeminin gösterilmesi için kontrast gerekmez. Yaygınlaşan alveoler ödem bilateral buzlu cam veya santral konsolidasyon oluşturup ARDS ve diğer alveoler hastalıklarla örtüşebilir. BT bulguları arasında ödem ve enfeksiyon örtüşebildiğinden, klinik bağlam ve ek görüntüleme bulguları ayırıcı tanıda önemlidir.

Faz ve pencere

Kontrastsız tanısal

Akciğer penceresinde düzgün interlobüler septal kalınlaşma, bronkovasküler kılıflarda kalınlaşma, santral/perihiler buzlu cam veya konsolidasyon; mediasten penceresinde kalp boyutu, plevral sıvı ve damar kalibresi incelenir. Ödem örüntüsünü göstermek için intravenöz kontrast fazı gerekli değildir.

Önerilen pencereler: Akciğer (G 1500 / M -600), Mediasten (G 350 / M 50).

BT bulguları

• Düzgün interlobüler septal kalınlaşma — interstisyum boyunca ince ve eşit kalınlıklı çizgiler olarak belirginleşir.
• Hidrostatik basınç artışı ve kapiller geçirgenlik değişiklikleri nedeniyle interstisyuma sızan sıvı, bronkovasküler demetler çevresinde birikerek kalınlaşma oluşturabilir.
• Sol kalp dolum basınçlarındaki artış, pulmoner venöz konjesyon ve hidrostatik ödeme yol açarak damar kalibre değişikliklerine neden olabilir.
• Perihiler buzlu cam — alveoler sıvı arttığında hilus çevresinde daha belirgin yamalı ya da yaygın opasite gelişebilir.
• Alveoler opasite — ödemde santral ağırlıklı yoğunluklar ve subpleural korunma örüntüsü gözlenebilir.
• Plevral efüzyon — ödemle birlikte tek veya çift taraflı plevral sıvı birikimi sık görülen bulgulardandır.
• Kardiyojenik akciğer ödemi, artmış sol kalp dolum basınçları ve tüm kalp hastalıklarının neden olabileceği hidrostasik sıvı birikimi ile karakterizedir.
• Hidrostatik yük artışı, plevral ve perikardiyal sıvı birikimine yol açabilir.

Normalde

Toraks radyolojisinde normal yapıların tanımı ve patolojik bulguların sınıflandırılması, Fleischner Derneği tarafından standartlaştırılan terminoloji sözlüğüne dayanır. Alt lob periferisinde şüpheli düzgün septaları, aynı düzeydeki karşı lobla ve normalde ince kalan bronş damar demetleriyle karşılaştırın; mediastinal pencerede kalp konturunu ve plevral sıvıyı ayrıca inceleyin.

Ayırıcı tanı

ARDS

alveol-kapiller geçirgenlik artışıyla ilişkili non-kardiyojenik ödem yapar; klinik tablo ve hidrostatik bulguların yokluğu ayrımı yönlendirir.

Akut eozinofilik pnömoni

düzgün septalar ve efüzyonla ödemi taklit edebilir; belirgin kalp-damar konjesyonu olmayabilir.

Diffüz alveoler kanama

santral buzlu cam ve konsolidasyon yapabilir; belirgin hidrostatik damar/septal bulgular tek başına beklenmez.

Lenfanjitik yayılım, düzgün ya da nodüler interlobüler septal kalınlaşma yapabilir ve pulmoner interstisyumu tutabilir.

Viral veya atipik enfeksiyon

buzlu cam ve septal çizgiler görülebilir; bronşiolit nodülleri, fokal konsolidasyon ve klinik enfeksiyon öyküsü ayrımda yardımcıdır.

Tuzaklar

• Kalp boyutunun normal olması akut kardiyojenik ödemi dışlamaz; akciğer damarları, venöz konjesyon ve sıvı dağılımını ayrı değerlendirin.
• Tek taraflı pozisyon veya amfizem, ödemi asimetrik gösterebilir; her iki akciğerdeki damar ve septa bulgularını karşılaştırın.
• Düzgün septalar özgül değildir; AEP ve bazı diğer interstisyel süreçler de benzer çizgiler yapabilir.
• Plevral efüzyonun yanındaki bağımlı alt lob opasitesi pasif atelektazi olabilir; bronş açıklığı ve hacim kaybını kontrol edin.

Kendini dene

1. Nefes darlığında BT'de düzgün septalar, bronkovasküler kılıf kalınlaşması, damar dolgunluğu ve bilateral sıvı görülüyor. En uyumlu tanı hangisidir?

   • Kardiyojenik pulmoner ödem
   • ARDS
   • Diffüz alveoler kanama
   • Lenfanjitik karsinomatozis
   Cevabı göster

   Kardiyojenik pulmoner ödem. Bu bulguların birlikte bulunması hidrostatik konjesyonu destekler. ARDS'de bağımlı heterojen opasite öne çıkabilir; kanama ve lenfanjitik yayılım tek başına damar dolgunluğu-plevral sıvı birlikteliğini açıklamaz.

2. HRCT'de düzgün interlobüler septal kalınlaşma, santral perihiler yumuşak doku kalınlaşması ve buzlu cam opasiteleri eşlik eden hastada eosinofili saptanıyor. En olası tanı hangisidir?

   • Lenfanjitik karsinomatozis
   • Akut eozinofilik pnömoni
   • Kardiyojenik ödem
   • Pneumocystis pnömonisi
   Cevabı göster

   Akut eozinofilik pnömoni. Düzgün septal kalınlaşma, santral perihiler yumuşak doku kalınlaşması, buzlu cam opasiteleri ve eosinofili birlikteliği, balon lavaj ile doğrulanabilen akut eozinofilik pnömoni açısından düşündürmelidir.

İlgili konular

• Akut respiratuvar distres sendromu akciğer örüntüsü

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 22 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. Dengue Hemorrhagic Fever: A State-of-the-Art Review Focused in Pulmonary Involvement.pubmed.ncbi.nlm.nih.gov
2. Pathophysiology, clinical features and radiological findings of differentiation syndrome/all-trans-retinoic acid syndrome.pubmed.ncbi.nlm.nih.gov
3. Handheld ultrasound as an adjunct to physical examination in the diagnosis of cardiopulmonary disease.pubmed.ncbi.nlm.nih.gov
4. Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure.pubmed.ncbi.nlm.nih.gov
5. Ventilatory management of patients with acute respiratory distress syndrome and optimization of lung mechanics.pubmed.ncbi.nlm.nih.gov
6. Value of Thoracic Echocardiography in the Diagnosis of Acute Heart Failure: Systematic Review and Meta-analysis.pubmed.ncbi.nlm.nih.gov
7. Lung Imaging in Acute Hypoxemic Respiratory Failure: From Physics to Bedside Applications.pubmed.ncbi.nlm.nih.gov
8. Lung B-line artefacts and their use.pubmed.ncbi.nlm.nih.gov
9. Phenotypes and personalized medicine in the acute respiratory distress syndrome.pubmed.ncbi.nlm.nih.gov
10. Lung ultrasonography findings in dogs with various underlying causes of cough.pubmed.ncbi.nlm.nih.gov
11. What's Next After ARDS: Long-Term Outcomes.pubmed.ncbi.nlm.nih.gov
12. 36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016.pubmed.ncbi.nlm.nih.gov
13. The Significance of Subpleural Sparing in CT Chest: A State-of-the-Art Review.pubmed.ncbi.nlm.nih.gov
14. Voriconazole-Induced acute interstitial pulmonary edema with angioedema: A case report.pubmed.ncbi.nlm.nih.gov
15. Case report: cerebral venous sinus thrombosis and pulmonary embolism as the initial presentation in a child with asymptomatic primary nephrotic syndrome.pubmed.ncbi.nlm.nih.gov
16. Primary Ciliary Dyskinesia.pubmed.ncbi.nlm.nih.gov
17. Primary ciliary dyskinesia phenotypes and correlation with genotype.pubmed.ncbi.nlm.nih.gov
18. Primary ciliary dyskinesia.pubmed.ncbi.nlm.nih.gov
19. Diagnostic accuracy of ultra-low-dose chest computed tomography in an emergency department.pubmed.ncbi.nlm.nih.gov
20. Idiopathic acute eosinophilic pneumonia.pubmed.ncbi.nlm.nih.gov
21. Hypersensitivity Pneumonitis and Acute Respiratory Distress Syndrome From E-Cigarette Use.pubmed.ncbi.nlm.nih.gov
22. [Expert recommendations for the diagnosis and treatment of interstitial lung disease caused by novel coronavirus pneumonia].pubmed.ncbi.nlm.nih.gov
23. Hantavirus infection in emergency radiology: Imaging manifestations, pathophysiology, and infection control considerations.pubmed.ncbi.nlm.nih.gov
24. Reversible Interlobular Septal 'Pearls' Associated with Takotsubo Cardiomyopathy and Heart Failure.pubmed.ncbi.nlm.nih.gov
25. Artificial intelligence improves detection and classification of pulmonary venous hypertension related to left ventricular diastolic dysfunction by chest radiography.pubmed.ncbi.nlm.nih.gov
26. Assessing volume status in heart failure: The role of renal duplex ultrasound in evaluating cardiorenal morbidity and heart failure mortality.pubmed.ncbi.nlm.nih.gov
27. Cardiogenic Pulmonary Edema in Emergency Medicine.pubmed.ncbi.nlm.nih.gov
28. Late Diagnosis of Noonan Syndrome Presenting With Infective Endocarditis: A Multidisciplinary Challenge in an Underserved Population.pubmed.ncbi.nlm.nih.gov
29. Discriminating HFrEF vs HFpEF from chest radiographs: Mitigating demographic performance gaps via augmentation and multimodal fusion.pubmed.ncbi.nlm.nih.gov
30. Diagnostic significance of lung ultrasound in evaluation of heart failure: A cross-sectional study in comparison with clinical assessment, proBNP, chest X-ray, and echocardiography.pubmed.ncbi.nlm.nih.gov
31. Correlation of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) with radiographic features of congestion in chest CT scan of patients with COVID-19.pubmed.ncbi.nlm.nih.gov
32. Reading chest radiographs in the critically ill (Part II): Radiography of lung pathologies common in the ICU patient.pubmed.ncbi.nlm.nih.gov
33. The pleuroparenchymal fibroelastosis atlas reveals aberrant cell states and their zonation as an alternate roadmap to lung fibrosis.pubmed.ncbi.nlm.nih.gov
34. Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal.pubmed.ncbi.nlm.nih.gov
35. Imaging of pulmonary emphysema: a pictorial review.pubmed.ncbi.nlm.nih.gov
36. Diffuse cystic lung diseases-a primer for radiologists.pubmed.ncbi.nlm.nih.gov
37. Advances in the mechanisms, imaging characteristics and management strategies for immune checkpoint inhibitor-related pneumonitis.pubmed.ncbi.nlm.nih.gov
38. Lung Ultrasound and High-Resolution Computed Tomography in Suspected COVID-19 Patients Admitted to the Emergency Department: A Comparison.pubmed.ncbi.nlm.nih.gov
39. Acute exacerbation in fibrotic interstitial lung disease: an international working group report.pubmed.ncbi.nlm.nih.gov
40. Medication-induced lung disease in children.pubmed.ncbi.nlm.nih.gov
41. Management of pneumonia by the emergency radiologist.pubmed.ncbi.nlm.nih.gov
42. Isolated pulmonary lymphangitic carcinomatosis as the initial manifestation of renal cell carcinoma.pubmed.ncbi.nlm.nih.gov
43. Pulmonary lymphangitic carcinomatosis mimicking interstitial lung disease.pubmed.ncbi.nlm.nih.gov
44. Multimodality Imaging for the Diagnosis and Evaluation of Pulmonary Sarcoidosis.pubmed.ncbi.nlm.nih.gov
45. Host, Pathogen, and Pulmonary Anatomy in Pneumonia: An Integrated Imaging and Clinical Perspective.pubmed.ncbi.nlm.nih.gov
46. Imaging in pulmonary infections of immunocompetent adult patients.pubmed.ncbi.nlm.nih.gov
47. The Impact of Genetics on Pediatric Interstitial Lung Diseases: A Narrative Literature Review and Clinical Implications.pubmed.ncbi.nlm.nih.gov
48. The Role of PoCUS in the Diagnosis and Early Monitoring of Cardiogenic Shock in the Emergency Department: A Narrative Review.pubmed.ncbi.nlm.nih.gov
49. Point-of-care ultrasound to evaluate volume status in congestive heart failure.pubmed.ncbi.nlm.nih.gov
50. Right Heart Catheterization: Best Practices and Specific Considerations.pubmed.ncbi.nlm.nih.gov
51. Ultrasound use in the ICU for interventional pulmonology procedures.pubmed.ncbi.nlm.nih.gov
52. Bioengineering and Clinical Translation of Human Lung and its Components.pubmed.ncbi.nlm.nih.gov
53. Coexistence of Autoantibodies against the Golgi Complex and Ro52 Antigen in a Patient with Nonspecific Interstitial Pneumonia.pubmed.ncbi.nlm.nih.gov
54. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach.pubmed.ncbi.nlm.nih.gov
55. Fleischner Society: Glossary of Terms for Thoracic Imaging.pubmed.ncbi.nlm.nih.gov
56. Lung Sonography in Critical Care Medicine.pubmed.ncbi.nlm.nih.gov
57. The "pandemic" increase in lung ultrasound use in response to Covid-19: can we complement computed tomography findings? A narrative review.pubmed.ncbi.nlm.nih.gov
58. Common and Rare Radiological Findings of Pulmonary and Thoracic Hydatid Cysts.pubmed.ncbi.nlm.nih.gov
59. ESR Essentials: imaging of common paediatric pulmonary diseases-practice recommendations by the European Society of Paediatric Radiology.pubmed.ncbi.nlm.nih.gov
60. Multimodality imaging of COVID-19 pneumonia: from diagnosis to follow-up. A comprehensive review.pubmed.ncbi.nlm.nih.gov
61. Diagnostic Challenges in Takotsubo Syndrome: Bridging Mimics, Mechanisms, and Management.pubmed.ncbi.nlm.nih.gov
62. Amphetamine-Associated Reversible Biventricular Cardiomyopathy Complicated by Acute Respiratory Failure: A Case Report.pubmed.ncbi.nlm.nih.gov
63. Mesalazine-Induced Myocarditis: A Challenging Diagnostic Journey.pubmed.ncbi.nlm.nih.gov
64. CT findings of lung injury during breast cancer treatment.pubmed.ncbi.nlm.nih.gov
65. Interstitial Lung Disease and Cardiotoxicity Associated with Trastuzumab Deruxtecan, Sacituzumab Govitecan, and Trastuzumab Emtansine: A Narrative Review.pubmed.ncbi.nlm.nih.gov
66. Immune Checkpoint Inhibitor-Related Pneumonitis in Renal Cell Carcinoma: Clinical Features, Mechanisms, and Lessons from Lung Cancer.pubmed.ncbi.nlm.nih.gov
67. Mitral Valve Prolapse Presenting as Unilateral Pulmonary Edema Mimicking Pneumonia.pubmed.ncbi.nlm.nih.gov
68. Carcinoid Heart Disease Presenting as Cardiogenic Shock: A Case Report.pubmed.ncbi.nlm.nih.gov
69. Imaging in the COVID-19 era: Lessons learned during a pandemic.pubmed.ncbi.nlm.nih.gov
70. Overview of treatment related complications in malignant pleural mesothelioma.pubmed.ncbi.nlm.nih.gov
71. Right ventricular-protective ventilation in acute respiratory distress syndrome: phenotypes, monitoring and ventilatory management.pubmed.ncbi.nlm.nih.gov
72. Emergency management of cerebral air gas embolism as a complication of CT-guided lung biopsy.pubmed.ncbi.nlm.nih.gov
73. Fatal Cerebral Air Embolism Following Central Venous Catheter Mishandling in a Stroke Patient: A Case Report.pubmed.ncbi.nlm.nih.gov
74. Lung ultrasound and the interstitial syndrome in tuberculosis endemic regions: illustrated insights from diverse clinical settings.pubmed.ncbi.nlm.nih.gov
75. Remote dielectric sensing for pulmonary congestion assessment: current concepts and clinical perspectives.pubmed.ncbi.nlm.nih.gov
76. Clinical correlates and short-term prognostic value of CT-detected subclinical pulmonary congestion in acute STEMI without overt heart failure.pubmed.ncbi.nlm.nih.gov
77. Beyond resection: imaging findings of expected and complicated postoperative changes in lung cancer.pubmed.ncbi.nlm.nih.gov
78. Myocardial Fibrosis Caused by Angiotensin II Implant in Rabbit Atherosclerosis Model Induced by High Cholesterol Diet.pubmed.ncbi.nlm.nih.gov
79. Imaging in patients with acute dyspnea when cardiac or pulmonary origin is suspected.pubmed.ncbi.nlm.nih.gov
80. Lung imaging methods: indications, strengths and limitations.pubmed.ncbi.nlm.nih.gov
81. Imaging of Childhood Interstitial Lung Disease.pubmed.ncbi.nlm.nih.gov
82. Pneumonitis Associated with Immune Checkpoint Inhibitors and Targeted Anticancer Therapies: A Retrospective Case Series of 12 Patients.pubmed.ncbi.nlm.nih.gov
83. New CT-Detected Pulmonary Abnormalities During Breast Cancer Chemotherapy: Frequency, Imaging Features, and Cumulative-Exposure Associations.pubmed.ncbi.nlm.nih.gov
84. Drug-Induced Interstitial Lung Disease in Lung Cancer Patients.pubmed.ncbi.nlm.nih.gov
85. Expert consensus on cancer treatment-related lung injury.pubmed.ncbi.nlm.nih.gov
86. COVID-19 Pneumonia: The Great Ultrasonography Mimicker.pubmed.ncbi.nlm.nih.gov
87. Challenges in the Differential Diagnosis of COVID-19 Pneumonia: A Pictorial Review.pubmed.ncbi.nlm.nih.gov
88. Pulmonary Complications in Children Following Hematopoietic Cell Transplantation: A Case Report and Review of the Diagnostic Approach.pubmed.ncbi.nlm.nih.gov
89. From Silent to Life-Threatening: Giant Left Atrial Myxoma Presenting with Acute Pulmonary Edema-A Case Report.pubmed.ncbi.nlm.nih.gov
90. Cardiogenic shock following acute MI in a young patient with familial hypercholesterolemia, and severe aortic stenosis: A case report.pubmed.ncbi.nlm.nih.gov
91. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints.pubmed.ncbi.nlm.nih.gov
92. Evaluation of Quantitative Computed Tomography Indices in Patients with Pneumonia and Acute Respiratory Failure in the Intensive Care Unit (ICU).pubmed.ncbi.nlm.nih.gov
93. Thoracic trauma WSES-AAST guidelines.pubmed.ncbi.nlm.nih.gov
94. Thoracic Computed Tomography to Assess ARDS and COVID-19 Lungs.pubmed.ncbi.nlm.nih.gov
95. Reporting and management of incidental lung findings on computed tomography: beyond lung nodules.pubmed.ncbi.nlm.nih.gov
96. Postoperative Pulmonary Complications: Clinical and Imaging Insightspubmed.ncbi.nlm.nih.gov
97. Pericardial Diseases: International Position Statement on New Concepts and Advances in Multimodality Cardiac Imaging.pubmed.ncbi.nlm.nih.gov
98. Management of the Diagnosis and Treatment of Pneumonia in an Aging Society.pubmed.ncbi.nlm.nih.gov
99. Pulmonary Edema: A Pictorial Review of Imaging Manifestations and Current Understanding of Mechanisms of Disease.pubmed.ncbi.nlm.nih.gov
100. Constrictive Pericarditis After Minimally Invasive Triple Valve Replacement: Insights From a Fatal Outcome.pubmed.ncbi.nlm.nih.gov
101. Percutaneous Interventions for Heart Failure in Congenital Heart Disease.pubmed.ncbi.nlm.nih.gov
102. Multimodal Imaging of Systemic Metastatic Myocardial and Vascular Calcification Associated with Renal Secondary Hyperparathyroidism in a Castrated Male Cat with End-Stage Chronic Kidney Disease: A Case Report.pubmed.ncbi.nlm.nih.gov
103. Multimodality Imaging in Eosinophilic Myocarditis: A Rare Cause of Heart Failure.pubmed.ncbi.nlm.nih.gov
104. Surgery for lung cancer: postoperative changes and complications-what the Radiologist needs to know.pubmed.ncbi.nlm.nih.gov
105. Radiological contribution to the diagnosis of early postoperative complications after lung resection for primary tumor: a revisional study.pubmed.ncbi.nlm.nih.gov
106. Lung Lymphatics in Edema, Inflammation, and Thrombosis.pubmed.ncbi.nlm.nih.gov
107. Uncommon Causes of Interlobular Septal Thickening on CT Images and Their Distinguishing Features.pubmed.ncbi.nlm.nih.gov
108. Chest radiography in adult critical care unit: A pictorial review.pubmed.ncbi.nlm.nih.gov
109. Prone position enhances oxygenation and facilitates weaning from percutaneous extracorporeal membrane oxygenation in infants after the bidirectional Glenn procedure.pubmed.ncbi.nlm.nih.gov
110. Ten Questions on Using Lung Ultrasonography to Diagnose and Manage Pneumonia in Hospital-at-Home Model: Part II-Confounders and Mimickers.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.