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Radiological appearance of pulmonary venous hypertension

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Chest radiology changes vary with respect to the developing pulmonary hypertension.

Early changes include Kerley B lines.

Later changes include:

  • fluffy appearance of horizontal veins in the lower zones. These veins are dilated due to increased venous pressure and may be mistaken for Kerley B lines.

  • upper lobe diversion - both a visual illusion and a real phenomenon:
    • the increased venous pressure causes transudate to drain into the interstitium and so reduces the contrast between fluid filled blood vessels and the background
    • the flow to the veins in the upper lobes is increased as a result of the more voluminous interstitium putting pressure on veins in the lower zones

  • peribronchial cuffing

  • pleural effusion - occurs as a result of transudative fluid within the pleural cavity

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