2. Case report
• A 94 years-old male arrives to health care unit
with severe cough, weakness and dizziness.
Obvious signs of swelling legs, ankles and feet
were present. Chief complaint- chest
discomfort. Physical examination was
performed including pulse rate measurements,
blood pressure, temperature and breath sounds.
The patient was sent to radiology department
to obtain chest radiographs: PA and Lateral
views. The reason for exam - congestive heart
failure, evaluate pulmonary edema.
3. CHF
• Congestive heart failure (CHF) refers to the
inability of the heart to propel blood at a rate and
volume sufficient to provide an adequate supply to
the tissues. Causes of CHF include an intrinsic
cardiac abnormality, hypertension, and any
obstructive process that abnormally increases the
peripheral resistance to blood flow. Intrinsic
cardiac abnormalities include insufficient or
defective cardiac filling and impaired contractions
for emptying.
4. Pulmonary
Edema
• Pulmonary edema refers to an abnormal
accumulation of fluid in the extravascular pulmonary
tissues. The most common cause of pulmonary
edema is an elevation of the pulmonary venous
pressure. This pressure is most often attributable to
left-sided heart failure but may also be caused by
pulmonary venous obstruction (mitral valve disease
and left atrial tumor) or lymphatic blockade (fibrotic,
inflammatory, or metastatic disease involving the
mediastinal lymph nodes). Other causes of
pulmonary edema include uremia, narcotic overdose,
exposure to noxious fumes, excessive oxygen, high
altitudes, fat embolism, adult respiratory distress
syndrome, and various neurologic abnormalities.
5. Radiographs obtained in
radiology department,
NYU Langone.
February 26, 2019
• Two views performed according to
protocol of the hospital.
• Gonadal shield was used during the entire
procedure.
• AP - 70 kvp and 2.0 mAs applied manually,
60 inches SID. Lateral – 120 kvp and 6.3
mAs while 72 inches SID applied.
• No contrast media.
• Digital Room used during the entire
procedure.
AP view, semi-
erect in stretcher.
Patient is unable
to stand.
Lateral view in a
stretcher,
horizontal beam.
Patient is in semi –
erect position.
6. Findings:
• The cardiac silhouette is enlarged and uncharged. There is
improvement of the bilateral airspace opacities likely secondary
to improving edema. There are bilateral small moderate pleural
effusions with bibasal atelectasis. February 26, 2019
• Based on the impression (improved pulmonary edema) – back
to medical history of the patient.
• December 13, 2014. PA and Lateral views of the chest were
obtained. Cardiac silhouette is enlarged. Prominent pulmonary
vascularity with perihilar airspace opacity, right greater than left
consistent with the clinical history of congestive heart failure
and pulmonary edema although pneumonia is not excluded.
Possible small bilateral pleural effusions. No pneumothorax.
7. Discussion (AP)
Collimation is slightly decreased;
Entire lung field visualized from the
apices to the costophrenic angles;
Patient is not properly aligned;
Trachea filled with air is not clearly
visible;
Heart shadow, left and right ventricles
enlarged;
Both lungs collapsed, bilateral
effusions;
Fluid collection at the bases of the
lungs;
Artifacts present . Proper marker.
8. Discussion (Lat)
Entire lung field visualized from the
apices to the costophrenic angles;
Arms are not overlapping the superior
part of the lungs;
Body is slightly rotated, posterior ribs are
not completely superimposed;
Sternum is not in a true lateral;
Open thoracic intervertebral spaces;
Heart shadow visualized, enlarged right
ventricle anteriorly;
Aortic arch;
Hilum of the lungs;
Artifacts present, proper marker;
Centering and collimation could be
improved.
9. Treatment of Congestive Heart
Failure and Pulmonary Edema
The nonpharmacologic approach to the treatment
of CHF and pulmonary edema involves avoiding
excessive physical stress, decreasing dietary salt,
and wearing compressive stockings to decrease the
incidence of deep vein thrombosis (DVT).
Pharmacologic therapy includes some combination
of the following drugs: diuretics, angiotensin-
converting enzyme inhibitors, digoxin (digitalis),
parenteral inotropic agents, calcium channel
blockers, beta-blockers, and antithrombotic
therapy.
