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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.

View larger version (17K): [in a new window]   Figure 1. Graph shows critical (Pcc) and effective (Pc') pulmonary capillary pressures at the 11 steps (time points) of the protocol. * indicates a P value less than .05 in a comparison with baseline values. The effective pulmonary capillary pressure exceeded the critical pulmonary capillary pressure, the capillary pressure above which lungs become edematous, at steps 4–8 of the protocol.

View larger version (19K): [in a new window]   Figure 2. Graph shows the left atrial pressure (Pla) and the mean pulmonary arterial pressure (Ppa) at the 11 steps (time points) of the protocol. * indicates a P value less than .05 in a comparison with baseline values. A progressive increase in the left atrial pressure was accompanied by a passive upstream increase in pulmonary arterial pressure, but there was persistent pulmonary hypertension when left atrial pressure was decreased back to baseline values.

View larger version (18K): [in a new window]   Figure 3. Graph shows the volume of extravascular lung water (EVLW) in milliliters and the arterial partial pressure of oxygen (PAO2) at the 11 steps (time points) of the protocol. * indicates a P value less than .05 in a comparison with baseline values. The volume of extravascular lung water increased as soon as the effective pulmonary capillary pressure exceeded the critical pulmonary capillary pressure (step 4 of the protocol). The arterial partial pressure of oxygen decreased as soon as the effective pulmonary capillary pressure equaled the critical pulmonary capillary pressure (step 3 of the protocol).

View larger version (18K): [in a new window]   Figure 4. Graph shows the mean attenuation values and the subjective CT scores (GG1) at the 11 steps (time points) of the protocol. * indicates a P value less than .05 in a comparison with baseline (time point 1) values. The ground-glass opacification score (GG1) increased as soon as the effective pulmonary capillary pressure became equal to the critical pulmonary capillary pressure (step 3 of the protocol). The mean attenuation value increased at the second measurement (step 5 of the protocol) after the effective pulmonary capillary pressure equaled the critical pulmonary capillary pressure.

View larger version (21K): [in a new window]   Figure 5. Graph shows the relationship between the mean attenuation and the extravascular lung water (EVLW) in milliliters. There was a close correlation between the mean attenuation value and the mean extravascular lung water. The vertical and horizontal bars indicate the SDs.

View larger version (147K): [in a new window]   Figure 6a. (a) Thin-section CT scan obtained at the baseline (time point 1) shows normal lung parenchyma. (b) Thin-section CT scan obtained when the effective pulmonary capillary pressure equaled the critical pulmonary capillary pressure (time point 3) shows diffuse ground-glass opacification. (c) Thin-section CT scan obtained 90 minutes after the effective pulmonary capillary pressure became higher than the critical pulmonary capillary pressure (time point 8) by 10 mm Hg shows diffuse ground-glass opacification and consolidations. (d) Thin-section CT scan obtained 60 minutes after the return of the left atrial pressure to the baseline value (time point 11) shows the remaining ground-glass opacification and consolidations.

View larger version (152K): [in a new window]   Figure 6b. (a) Thin-section CT scan obtained at the baseline (time point 1) shows normal lung parenchyma. (b) Thin-section CT scan obtained when the effective pulmonary capillary pressure equaled the critical pulmonary capillary pressure (time point 3) shows diffuse ground-glass opacification. (c) Thin-section CT scan obtained 90 minutes after the effective pulmonary capillary pressure became higher than the critical pulmonary capillary pressure (time point 8) by 10 mm Hg shows diffuse ground-glass opacification and consolidations. (d) Thin-section CT scan obtained 60 minutes after the return of the left atrial pressure to the baseline value (time point 11) shows the remaining ground-glass opacification and consolidations.

View larger version (182K): [in a new window]   Figure 6c. (a) Thin-section CT scan obtained at the baseline (time point 1) shows normal lung parenchyma. (b) Thin-section CT scan obtained when the effective pulmonary capillary pressure equaled the critical pulmonary capillary pressure (time point 3) shows diffuse ground-glass opacification. (c) Thin-section CT scan obtained 90 minutes after the effective pulmonary capillary pressure became higher than the critical pulmonary capillary pressure (time point 8) by 10 mm Hg shows diffuse ground-glass opacification and consolidations. (d) Thin-section CT scan obtained 60 minutes after the return of the left atrial pressure to the baseline value (time point 11) shows the remaining ground-glass opacification and consolidations.

View larger version (178K): [in a new window]   Figure 6d. (a) Thin-section CT scan obtained at the baseline (time point 1) shows normal lung parenchyma. (b) Thin-section CT scan obtained when the effective pulmonary capillary pressure equaled the critical pulmonary capillary pressure (time point 3) shows diffuse ground-glass opacification. (c) Thin-section CT scan obtained 90 minutes after the effective pulmonary capillary pressure became higher than the critical pulmonary capillary pressure (time point 8) by 10 mm Hg shows diffuse ground-glass opacification and consolidations. (d) Thin-section CT scan obtained 60 minutes after the return of the left atrial pressure to the baseline value (time point 11) shows the remaining ground-glass opacification and consolidations.