CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 2 Pulmonary Edema Pattern (Symmetric
Bilateral Alveolar Pattern)

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig C 2-1 Congestive heart failure. Diffuse bilateral symmetric infiltration of the
central portion of the lungs along with relative sparing of the periphery produces
the butterfly, or bat's wing, pattern. The margins of the edematous lung are
sharply defined. The consolidation is fairly homogeneous and is associated with a
well-defined air bronchogram on both sides.7

4. • Fig C 2-2 Unilateral pulmonary edema due to
dependency. Diffuse alveolar pattern is limited
to the left lung.

5. • Fig C 2-3 Chronic renal failure. Typical perihilar
alveolar densities producing the butterfly pattern
of uremic lung. Unlike pulmonary edema due to
congestive heart failure, in chronic renal failure
the cardiac silhouette is of normal size.

6. • Fig C 2-4 Fluid overload. Pulmonary edema
pattern developing in the postoperative
period in an elderly patient. Note the
endotracheal tube and pulmonary artery
catheter

7. • Fig C 2-5 Neurogenic pulmonary edema. Diffuse bilateral
air-space consolidations with a heart of normal size and no
evidence of pleural effusions or Kerley lines.109

8. • Fig C 2-6 Hydrocarbon poisoning. Diffuse
pulmonary edema pattern, with the alveolar
consolidation most prominent in the central
portions of the lung.

9. • Fig C 2-7 Near-drowning. Diffuse pulmonary
edema pattern.

10. • Fig C 2-8 Fat embolism. (A) Frontal chest radiograph made 3
days after a leg fracture demonstrates diffuse bilateral air-
space consolidation due to alveolar hemorrhage and
edema. Unlike cardiogenic pulmonary edema, the
distribution in this patient is predominantly peripheral
rather than central, and the heart is not enlarged. (B)
Recumbent radiograph of the knee obtained with a
horizontal beam demonstrates the characteristic fat-blood
interface (arrow) in a large suprapatellar effusion. Marrow
fat that enters torn peripheral vessels can be trapped by
the pulmonary circulation and lead to diffuse alveolar
consolidation.8

11. • Fig C 2-9 Amniotic fluid embolism. (A) Initial
film 6 hours after the onset of acute
symptoms, showing heavy bilateral perihilar
infiltrate. (B) Twelve hours later, the infiltrates
have become more confluent in the perihilar
zones.9

12. • Fig C 2-10 Thoracic trauma. Continuous positive-
pressure ventilation has caused diffuse interstitial
emphysema, pneumothorax, and
pneumoperitoneum to be superimposed on a
pattern of diffuse alveolar opacities.

13. • Fig C 2-11 Pulmonary hemorrhage. (A) Diffuse
bilateral air-space consolidation developed in
a patient receiving high-dose anticoagulant
therapy. (B) With resolution of the
hemorrhage, a reticular pattern is seen in the
same distribution as the alveolar infiltrate.

14. • Fig C 2-12 Goodpasture's syndrome. Frontal chest film in a patient with
massive pulmonary hemorrhage demonstrates extensive bilateral
pulmonary consolidation, which is confluent in most areas. Note the
normal heart size.

15. • Fig C 2-13 Heroin abuse. (A) Initial radiograph
obtained shortly after presentation to the
emergency department reveals bilateral areas
of increased opacity, a finding consistent with
acute lung injury. (B) Follow-up study obtained
two days later shows complete clearing of the
areas of increased opacity. Such rapid clearing
is common in heroin-induced lung injury.10

16. • Fig C 2-14 Cocaine abuse. Extensive bilateral heterogeneous central
and parahilar opacities representing cardiogenic pulmonary edema
in a woman who presented with shortness of breath and chest pain
after smoking crack cocaine.11

17. • Fig C 2-15 Adult respiratory distress syndrome.
Ill-defined areas of alveolar consolidation with
some coalescence scattered throughout both
lungs.

18. • Fig C 2-16 Plague pneumonia. Diffuse air-
space consolidation involves both lungs.

19. • Fig C 2-17 Pneumocystis carinii pneumonia in
acquired immunodeficiency syndrome. Diffuse
bilateral pulmonary infiltrates.

23. • Fig C 2-18 Alveolar microlithiasis. Nearly uniform distribution of
typical fine, sand-like mottling in the lungs. The tangential shadow
of the pleura is displayed along the lateral wall of the chest as a
dark lucent strip (arrows).12

24. • .
• Fig C 2-19 Pulmonary alveolar proteinosis.
Diffuse, bilateral air-space consolidation
predominantly involves the central portions of
the lung and simulates pulmonary edema. The
patient was asymptomatic, and serial radiographs
over several months showed little change

25. • Fig C 2-20 Sarcoidosis. Diffuse reticular
nodular and alveolar infiltrates.