25-37 to 25-42).16,19,53 Nodules tend to involve the basal portions of lungs, possibly related to preferential blood flow.16 Larger lesions are termed cannonball metastasis. Likewise, creatine phosphokinase-MB (CPK-MB) and troponin levels are useful in patients with suspected cardiogenic pulmonary edema to rule out myocardial infarction. In marked contrast with ARDS, extrapulmonary organ failure or shock is exceptional; however, a few cases of fatal IAEP have been reported. In patients with Kerley lines, the x-ray will have a fine threading of opaque lines, indicating that fluid is present. If you see Kerley B lines on a chest X-ray in suspected heart failure, then they are a very helpful sign to help diagnose interstitial oedema. Once the magnitude of pulmonary edema is sufficiently severe to lead to persistent airway closure or alveolar flooding, it is very difficult to separate edema, atelectasis, and inflammation on chest radiographs. ). These cardiovascular changes include cardiomegaly, prominence of upper-lobe vessels, constriction of lower-lobe vessels, and prominent hilar vessels. In addition, any cause of severe hypoproteinemia, including cirrhosis and nephrosis, may lead to interstitial edema. IAEP occurs mainly in young adults, with a male predominance and no previous asthma history. When the effusion is atypical (e.g., predominantly left sided) or if it increases after the pulmonary edema has begun to clear, the possibility of embolism should be considered. Pleural and pericardial effusions are the most common radiologic manifestations of systemic lupus erythematosus (Fig 4.6, A and B).632 This diagnosis is rarely suggested by the radiologist. Kerley A lines are long and typically do not branch. Other laboratory tests should be directed at potential causes of ALI. Secondary Lung Lobule Normal lung histology This image is a panoramic view of the lung showing secondary lobules and interlobular septa. In several cases, IAEP developed soon after the initiation of tobacco smoking or change in smoking habits. Pleural effusion is a common manifestation accompanying lung metastasis or may signify pleural metastasis. 36.4). Patients with IAEP often are admitted to the intensive care unit. A history of dietary indiscretion is common in patients with an acute exacerbation of chronic congestive heart failure. Features: Short - about 1-2 cm long. Linee Kerley B Queste sono brevi (1-2 cm) linee che rappresentano i setti interlobulari periferici: sono parallele tra loro e perpendicolari rispetto alla pleura.Si trovano perifericamente a contatto con la pleura, ma sono generalmente assenti lungo le superfici fissurali. They are thin linear pulmonary opacities caused by fluid or cellular infiltration into the interstitium of the lungs. Ngoài ra còn có thể gặp đường Kerley D ở vùng sau xương ức trên phim nghiêng. Kerley B lines are linear opacities seen on the chest radiograph. Increased permeability pulmonary edema is also known as ALI or ARDS in its severest form. Another potential advantage of pulmonary artery catheterization is that the hemodynamic data may be useful in guiding fluid and vasopressor therapy. Eosinophilia also may be found in pleural effusion or sputum samples. They represent thickening of the interlobular septa of the periphery of the lungs. These are more properly referred to as septal lines. On lung examination, patients with ALI may have bilateral rales or evidence of consolidation, but these findings are non-specific. Kerley B-lines: These occur in the area of the pulmonary periphery of the middle lobe, the lingula and the lower lobe. Other possible diagnostic studies in ALI include pulmonary artery catheterization and echocardiography. Vincent Cottin, Jean-François Cordier, in Clinical Respiratory Medicine (Fourth Edition), 2012. 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