Prevalence
Causes
Clinical
features
Differential
diagnosis
Investigations
Therapy
Prevention
Prognosis
|  | | | Investigations |
-
In cases of clear pulmonary
oedema
look for b
-
pulmonary blood-flow distribution
(upper fields predominating make heart failure much more likely)
-
pulmonary oedema distribution
(even distribution make heart failure more likely; central or patchy distribution makes it less likely)
-
vascular pedicle width
(a narrow width makes heart failure less likely)
Why?
Inverted pulmonary blood flow and even pulmonary oedema make heart
failure more likely
| Patient b
|
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
|
on intensive care with radiographic evidence of pulmonary
oedema
|
heart failure
(physiological evaluation or histology)
|
Pulmonary blood flow distribution
normal
|
0.48
(0.23 to
0.97)
|
|
|
|
balanced
|
0.58
(0.40 to
0.84)
|
|
|
|
inverted
|
14
(3.5 to
55)
|
|
|
|
Distribution of pulmonary
oedema
patchy
|
0.0
(0.0 to 0.24)
|
|
|
|
central
|
0.16
(0.066 to 0.38)
|
|
|
|
even
|
3.3
(2.2 to
5.1)
|
|
|
|
Vascular pedicle width
narrow
|
0.29
(0.083 to 0.98)
|
|
|
|
normal
|
1.5
(0.85 to 2.5)
|
|
|
|
wide
|
1.0
(0.74 to 1.4)
|
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
|
on intensive care with radiographic evidence of pulmonary
oedema
|
overhydration
(physiological evaluation or histology)
|
Pulmonary blood flow distribution
normal
|
0.57
(0.27 to
1.3)
|
|
|
|
balanced
|
1.9
(1.4 to
2.6)
|
|
|
|
inverted
|
0.0
(0.0 to
0.40)
|
|
|
|
Distribution of pulmonary
oedema
patchy
|
0.0
(0.0 to
0.70)
|
|
|
|
central
|
6.5
(3.6 to
12)
|
|
|
|
even
|
0.27
(0.13 to
0.56)
|
|
|
|
Vascular pedicle width
narrow
|
0.0
(0.0 to
0.20)
|
|
|
|
normal
|
0.45
(0.19 to
1.1)
|
|
|
|
wide
|
5.7
(3.4 to
9.7)
|
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
|
on intensive care with radiographic evidence of pulmonary
oedema
|
ARDS
(physiological evaluation or histology)
|
Pulmonary blood flow distribution
normal
|
2.6
(1.4 to
4.9)
|
|
|
|
balanced
|
0.97
(0.64 to
1.5)
|
|
|
|
inverted
|
0.22
(0.057 to
0.88)
|
|
|
|
Distribution of pulmonary
oedema
patchy
|
infinity
(13 to
infinity)
|
|
|
|
central
|
0.67
(0.31 to 1.5)
|
|
|
|
even
|
0.52
(0.31 to 0.88)
|
|
|
|
Vascular pedicle width
narrow
|
11
(3.2 to
37)
|
|
|
|
normal
|
1.2
(0.65 to
2.1)
|
|
|
|
wide
|
0.43
(0.24 to
0.79)
|
-
Pulmonary blood-flow distribution:
-
normal: lower lung fields predominate (typical of ARDS)
-
balanced: equal in lower and upper lung fields (typical of overhydration and some heart failures)
-
inverted: upper lung fields predominate (typical of heart failure, and
rules out overhydration)
-
Distribution of pulmonary oedema
-
Even: homogenous from chest wall to heart & obeys gravity (typical of heart failure)
-
Central: perihilar only (typical of overhydration)
-
Patchy: spares many areas & often displays air bronchograms (rules out heart and overhydration, and rules in ARDS)
-
Vascular pedicle width: (just above aortic knob)
-
Narrow: <43 mm (virtually rules out overhydration)
-
Normal: 43-53 mm (seen in all three)
-
Wide: >53 mm (overhydration)
|
internal medicine