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Classic finding of congestive heart failure on chest
x-ray:
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Increased
heart size -- cardiothoracic ratio >0.50.
Note: in some series older women without
heart disease may have cardiothoracic ratios
slightly greater than 0.50.
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Large hila with indistinct margins
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Prominence of superior pulmonary veins;
cephalization of flow
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Fluid in interlobar fissures
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Pleural effusion
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Kerley B lines
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Alveolar edema
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Peribronchial cuffing
Features Favoring ARDS
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Clinical history of risk factors
for ARDS
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Peripheral infiltrates on chest
radiograph
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PCWP < 18 mm Hg
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BALF is proteinaceous and
inflammatory
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Pathological examination shows
diffuse alveolar damage, type II pneumocyte hyperplasia
with or without fibrosis
X-ray Findings
• No cardiomegaly
• No pleural effusions
• No Kerley B lines
• Delay in onset of any x-ray findings for at
least 12 hours post-insult
Between 12 and 24 hours
• Patchy alveolar infiltrates in both lungs
• Between 24 and 48 hours
• Coalesce to produce massive air-space
consolidation of both lungs
From 5 to 7 days
• Clearing is frequently 2° effects of CPP
ventilation rather than true healing
• Pneumonia may superimpose
• Difficult to recognize but look for new
focal infiltrates and pleural effusion
More than one week
• Coarse reticular interstitial disease which
may lead to fibrosis
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