Acute pulmonary edema
Recommended: Chest X-ray + Bedside Echo (for cardiac function) is the preferred imaging study for acute pulmonary edema. CXR pattern (cephalization, Kerley B, cardiomegaly, effusions).
Recommended study
Chest X-ray + Bedside Echo (for cardiac function)
CXR pattern (cephalization, Kerley B, cardiomegaly, effusions). POCUS lungs (B-lines) is highly sensitive.
If the default doesn't apply
Non-cardiogenic etiology suspected (ARDS, neurogenic)
CT
CT Chest with IV contrast
IV contrast
Need real-time cardiac function
US
Bedside echocardiogram
No contrast
Watch-outs
Flash pulmonary edema with hypertensive crisis
Often indicates renal artery stenosis or aortic stenosis — image the cause once stabilized.
BNP / NT-proBNP interpretation
Elevated in obesity, renal failure, age; not specific. Use clinical and imaging context.
Pearls
- Lung POCUS: ≥ 3 B-lines per intercostal space in multiple zones suggests cardiogenic pulmonary edema.
- Bat-wing edema pattern is classic but uncommon — most show diffuse interstitial / alveolar pattern.
- Pulmonary edema can be unilateral when patient lies on that side or with vascular shunting.