Pulmonary Venous Hypertension in X-Ray

Pulmonary venous hypertension, by its name, is increased venous pressure in..

Pulmonary venous hypertension, by its name, is increased venous pressure in the lungs. This is seen when the veins are unable to drain the lungs adequately to the heart, which might be because the heart has no more place to drain ( constricted heart in case of constrictive pericarditis, pericardial effusion) or when the heart cannot pump drained fluid ( congestive heart disease) or sometimes when there is more fluid which may go to the lungs ( fluid overload).

It can be diagnosed by the stages-

a) In the first stage, there will be cephalization of the vessels. This means that the upper lobe vessels will be larger than the lower lobe vessels. In normal patients, the lower lobe vessels are larger, partly due to gravity and also due to the increased size of the lower lobe.

In this image, see that the upper lobe vessels are prominent and more dilated than the lower lobe vessels. This is cephalization of vessels

b) In the second stage- due to increased pulmonary venous pressure, the fluid in the veins reflux back to the interstitium, so we will see interstitial edema. This will be represented by horizontal lines in the bases of the lungs.

Here, we can see there is a presence of cephalization of vessels. Also, horizontal lines are noted in the bases of the lungs ( Yellow arrows). Left-sided pleural effusion also noted. This is a case of Pulmonary venous hypertension. 

Case courtesy of Dr. Ian Bickle, Radiopaedia.org, rID: 74968

c) In the final stage, there will be alveolar edema, because the fluid in the alveoli pours into the alveoli. So, we will see bilateral perihilar opacities, without clear delineation of hilar vascularity. This stage is also known as Cardiogenic pulmonary edema.

In this image, you can note the presence of bilateral perihilar opacities, which is due to pulmonary edema, also known as ‘ Bat wing’ pattern of opacities. This is the third stage of pulmonary venous hypertension.


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