CHF

Heart Failure

The Common Vein

Copyright 2009

Left Heart Failure

    • Heart failure due to left ventricular dysfunction
      • heart failure with reduced ejection fraction (HFrEF)
        • ejection fraction (EF) of less than 40%.,
      • heart failure with preserved ejection fraction (HFpEF), and
        • heart failure with an EF of greater than 50%.
      • heart failure with mid-range ejection fraction (HFmrEF).
        • EF of 40% to 50% T

Acute Pulmonary Edema
In this patient with acute congestive cardiac failure the consolidation that has hilar distribution has reminded radiologists of bat wings and is caused by alveolar edema. As a result of the fluid in the alveoli, gas exchange across the respiratory membrane is reduced and required intubation to improve the gas exchange process. Note the endotracheal tube as well as the central venous line that is used to assess the heart pressure and monitor the congestion. Courtesy Ashley Davidoff MD 42073b01 heart cardiac interstitia; edema alveolar edema batwing CHF congestive cardiac failure CXR plain film

Atlas of Pathology

Normal Alveoli
Pleura Note thin mesothelial membrane lying on top of alveolated lung parenchyma. This represents the visceral pleura. Courtesy Armando Fraire MD 32648 code lung pulmonary pleura normal alveolus alveoli histology interstium interstitial

Normal Secondary Lobule

Interlobular Septa
Normal lung histology This image is a panoramic view of the lung showing secondary lobules and interlobular septa. Within the interalveolar septae, one sees small venules and lymphatics.Courtesy Armando Fraire MD. 32649b code lung pulmonary alveoli alveolus secondary lobule interlobular septa vein lymphatic histology interstitium interstitial

Normal Secondary Lobule
The arteries and airways pair up and travel together down the respiratory tree branching in exactly the same way until they reach the pulmonary lobule. The pulmonary lobule, also called the secondary lobule is a structural unit surrounded by a membrane of connective tissue, and it is smaller than a subsegment of lung but larger than an acinus. This diagram shows two secondary lobules lying side by side. The pulmonary arteriole (royal blue) and bronchiole (teal) are shown together in the centre of the lobule (“centrilobular”), with two other pairs of bronchovascular bundles, while the oxygenated pulmonary venules (red) and lymphatics (yellow) are peripheral and also form formidable and almost inseparable pairs.

Courtesy Ashley Davidoff MD Copyright 2009 42440b03

Cephalization
44659.800 chest lung CXR cephalisation cephalization pulmonary arteries pulmonary artery fx distended distension fx pulmonary congestion dx CHF dx congestive heart failure cardiac imaging radiology Courtesy Ashley Davidoff MD

Size of the Upper Lobe Brancjh artery to airway Ratio
44659c03.800 Copyright 2009 Davidoff MD

Interstitial Edema
46421 heart cardiac chest lung fx pulmonary congestion bilateral effusions interstitial edema Kerley B lines thickening of the fissure left atrial enlargement elevation of the mainstem bronchus cardiomegaly ‘fx enlarged dx congestive heart failure CHF cardiac failure CXR plain film Davidoff MD 46424c01 46421 46422 46423 46424

Kerley B Lines
46423 heart cardiac lung chest fx pulmonary congestion interstitial edema Kerley B lines Kerley A line Kerley C lines dx congestive heart failure CHF cardiac failure CXR plain film Davidoff MD 46424c01 46421 46422 46423 46424

Progression From Normal to Complete White Out
41972c Courtesy Ashley Davidoff MD medical students code alveolar edema cardiac cardiac failure congestion enlargement heart lung whiteout
MITRAL STENOSIS AND PULMONARY HYPERTENSION
87 year old male with mitral stenosis and mild MR with enlarged left atrium, and right ventricle with pulmonary hypertension and probable mild LV enlargement as well
Ashley Davidoff MD
87 year old male with mitral stenosis and mild MR with enlarged left atrium, and right ventricle and probable mild LV enlargement as well
Ashley Davidoff MD
This image is a panoramic view of the lung showing almost rectangular secondary lobules surrounded by interlobular septa (cream borders) The distal bronchioles (teal) and pulmonary arteriole (royal blue are shown in the centre of a lobule in the right lower corner. The branches of these two structures are shown in the secondary lobule with the acinar airways shown in teal and the presumed course artistically inferred in royal blue. Within the interlobular septa (light pink) remnants of the pulmonary venules (red – inferred) and lymphatics (yellow inferred) course going in the opposite direction to the arteriole and the airways. Courtesy Armando Fraire MD. 
Keywords:
lung pulmonary alveoli alveolus secondary lobule interlobular septa vein lymphatic histology interstitium interstitial normal copyright 2020 all rights reserved
Courtesy of: Armando Fraire, M.D.

 

CHF – Alveolar Edema
CT scan shows Diffuse ground glass pattern with thickening of the interlobular septa and manifesting as crazy paving pattern
Ashley Davidoff MD
CHF with Mosaic attenuation Ashley Davidoff MD TheCommonVein.net

References and Links

Malik, A, et al Congestive Heart Failure Stat Pearls September 2021

Ahmad;