Preliminary Diagnosis: Pulmonary Edema

I. What imaging technique is first-line for this diagnosis?

Chest X-ray, PA, and lateral views.

II. Describe the advantages and disadvantages of this technique for diagnosing pulmonary edema.

Advantages

  • Relatively inexpensive and fast imaging modality.

  • Highly portable.

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  • Exposes patients to minimal ionizing radiation.

  • Plain radiography is highly sensitive.

Disadvantages

  • Less adept (less sensitive) in detailing any underlying parenchymal or pleural process or secondary complication compared to cross sectional imaging.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant patients.

IV. What alternative imaging techniques are available?

CT of the chest with and/or without contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing pulmonary edema.

Advantages

  • More sensitive and specific in detailing any primary parenchymal or pleural abnormality and detecting and characterizing any secondary complications.

  • May potentially help guide treatment.

  • Offers exquisite detail of lung architecture, which may be beneficial in patients with underlying complex obstructive and restrictive lung diseases.

Disadvantages

  • Exposes patients to significantly more ionizing radiation, compared to plain radiography.

  • Less portable and more expensive as compared to plain radiography.

VI. What are the contraindications for the alternative imaging techniques?

  • May be contraindicated in pregnant patients.

  • Relative contraindication to contrast in patients with renal failure.

  • Relative contraindication to contrast in patients with a contrast allergy.

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