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Comparison of Chest Computed Tomography Features in the Acute Phase of Cardiogenic Pulmonary Edema and Acute Respiratory Distress Syndrome on Arrival at the Emergency Department

Komiya, Kosaku MD*,†; Ishii, Hiroshi MD, PhD*; Murakami, Junji MD, PhD; Yamamoto, Hidehiko MD, PhD; Okada, Fumito MD, PhD§; Satoh, Katashi MD, PhD; Takahashi, Osamu MD, MPH, PhD; Tobino, Kazunori MD, PhD; Ichikado, Kazuya MD, PhD#; Johkoh, Takeshi MD, PhD**; Kadota, Jun-ichi MD, PhD*

doi: 10.1097/RTI.0b013e31828d40b2
Original Articles

Purpose: Discriminating cardiogenic pulmonary edema (CPE) from acute respiratory distress syndrome (ARDS) is a serious problem in emergency departments, and the ability of chest radiographs to differentiate between these 2 entities is limited. We compared the chest computed tomography (CT) findings in the acute phase of CPE with those of ARDS.

Materials and Methods: Outpatients with acute respiratory failure presenting to emergency departments with bilateral pulmonary opacities were enrolled. The patients included not only those who visited our hospital first but also those referred from other hospitals. Two intensivists who were blinded to the results of the chest imaging studies reviewed the patients’ clinical records independently in order to determine a diagnosis of CPE or ARDS, and the chest CT findings were independently evaluated by 2 radiologists who were unaware of the patients’ clinical information. The positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the statistically different findings were calculated using standard definitions.

Results: Forty-one patients with CPE and 20 patients with ARDS were assessed. Upper-lobe–predominant ground-glass attenuation, central-predominant ground-glass attenuation, and central airspace consolidation were associated with high PPVs (95.2%, 92.3%, and 92.0%, respectively) and moderate NPVs (47.5%, 51.4%, and 50.0%, respectively) to diagnose as CPE. Left-dominant pleural effusion and small ill-defined opacities revealed relatively high PPVs (71.4% and 58.3%, respectively) and NPVs (72.2% and 73.5%, respectively) to diagnose as ARDS. The overall accuracy of the diagnosis by chest CT was 88.5% (54/61).

Conclusions: Chest CT may be a useful tool for differentiating CPE from ARDS in the emergency department setting.

Departments of *Internal Medicine 2

§Radiology, Oita University Faculty of Medicine, Yufu

Departments of Radiology

Respiratory Medicine, Iizuka Hospital, Iizuka

Department of Nursing Science, Kagawa Prefectural College of Health Sciences, Muremachi, Takamatsu

Center for Clinical Epidemiology, St. Luke’s Life Science Institute, Chuoku, Tokyo

#Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto

**Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Japan

The authors declare no conflicts of interest.

Reprints: Kosaku Komiya, MD, Department of Internal Medicine 2, Oita University Faculty of Medicine, Oita, Japan, 1-1 Idaigaoka Hasama-machi, Oita 879-5593, Japan (e-mail:

© 2013 by Lippincott Williams & Wilkins