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Hydrostatic Pulmonary Edema: Evaluation with Thin-Section CT in Dogs¹

¹ From the Department of Radiology (P.S., J.S., P.A.G.) and the Laboratory of Physiology (M.D., P.L., C.M., R.N.), Erasme University Hospital, Route de Lennik, 808-1070 Brussels, Belgium. R.N. supported in part by Fonds de Recherche Scientifique et Médicale grants 9.4513.94 and 3.4517.95. Received March 16, 1998; revision requested May 13; final revision received September 9; accepted October 22. Address reprint requests to P.A.G.

PURPOSE: To identify the hemodynamic determinants of ground-glass opacification on thin-section computed tomographic (CT) scans of hydrostatic pulmonary edema and to compare attenuation and subjective assessments of ground-glass opacification with extravascular lung water.

MATERIALS AND METHODS: Left atrial pressure, pulmonary arterial pressure, effective pulmonary capillary pressure, and extravascular lung water were measured in six dogs before and during progressive increase of effective pulmonary capillary pressure. A thin-section CT scan was obtained at each step. Lung attenuation and subjective assessments of ground-glass opacification were compared with hemodynamic variables and extravascular lung water.

RESULTS: Ground-glass opacification was identified when effective pulmonary capillary pressure equaled critical pulmonary capillary pressure. Extravascular lung water increased, and the distribution curve of lung attenuation coefficients shifted to higher attenuation from the second measurement at an effective pulmonary capillary pressure greater than the critical pulmonary capillary pressure. Attenuation was highly correlated (r = 0.98, P < .001) with extravascular lung water; ground-glass opacification was detected before a significant (P = .615, analysis of variance) increase in extravascular lung water.

CONCLUSION: Thin-section CT depicts ground-glass opacification when effective pulmonary capillary pressure equals critical pulmonary capillary pressure and before a detectable increase in extravascular lung water. Attenuation reflects extravascular lung water.

Index terms: Computed tomography (CT), thin-section, 60.12111 • Heart, failure, 51.71 • Lung, CT, 60.12111 • Lung, fluid, 60.71 • Lung, function, 60.91

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