Published ahead-of-print in JTI is “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” by K. Komiya and colleagues from Japan.
The authors reviewed CT scans of 61 patients, 41 with cardiogenic lung edema and 20 with acute respiratory distress syndrome (ARDS), and compared the findings. The authors found that upper lobe and central predominant ground-glass opacity, central-predominant lung consolidation, and peribronchovascular thickening were more common in patients with cardiogenic lung edema. In contrast, patients with ARDS were more likely to have even distribution of ground-glass opacity in all lobes, even distribution of lung consolidation, and small ill-defined opacities. Other findings such as gravitational dependence, septal lines, and air bronchograms were not significantly different between groups. The above described distribution of ground-glass opacity and lung consolidation in patients with cardiogenic lung edema had the highest positive predictive values (> 92%).
Despite some limitations, which include the lack of reference standard for diagnosis of ARDS and retrospective study design, the authors conclude that CT may play a role in assessing selected patients when the distinction between cardiogenic lung edema and ARDS is not clear based on clinical findings only.