From the Guidelines
CT chest findings that represent volume overload in congestive heart failure (CHF) include ground-glass opacities, interlobular septal thickening, and pleural effusions, as well as enlarged central pulmonary arteries, cardiomegaly, and peribronchial cuffing, as noted in the most recent study 1. These findings are characteristic of CHF-related volume overload, which occurs due to increased hydrostatic pressure in the pulmonary vasculature and subsequent fluid extravasation into the lung parenchyma and pleural space. Some key points to consider when evaluating CT chest findings for volume overload in CHF include:
- Ground-glass opacities appear as hazy areas of increased lung density, often in a central or perihilar distribution, representing fluid in the alveoli.
- Interlobular septal thickening manifests as thin lines at the periphery of the secondary pulmonary lobules, indicating fluid accumulation in the interstitial space.
- Bilateral pleural effusions are common and appear as fluid collections in the pleural space.
- The distribution of these findings is typically symmetrical and more pronounced in dependent lung regions due to gravitational effects. It is essential to consider these findings in the context of the patient's clinical presentation and other diagnostic tests, such as echocardiography and laboratory results, to confirm the diagnosis of CHF and guide management decisions, as recommended by recent guidelines 1.
From the Research
Computed Tomography (CT) Chest Findings for Volume Overload in Congestive Heart Failure (CHF)
The following CT chest findings are associated with volume overload in CHF:
- Enlarged heart 2
- Bilateral interlobular thickening 2
- Bilateral pleural effusion 2
- Increased vascular diameter 2
- Bilateral ground-glass opacification 2
CT Signs and Their Association with Acute Heart Failure (AHF)
These CT signs have been identified as independent predictors of AHF:
- Enlarged heart (multivariate odds ratio: 20.38) 2
- Bilateral interlobular thickening (multivariate odds ratio: 11.67) 2
- Bilateral pleural effusion (multivariate odds ratio: 6.39) 2
- Increased vascular diameter (multivariate odds ratio: 4.49) 2 The presence of two or more of these CT signs is associated with a high probability of AHF, while the absence of these signs indicates a low probability 2
High-Resolution CT Findings in Hydrostatic Pulmonary Edema
High-resolution CT can detect hydrostatic pulmonary edema, which is characterized by an abnormal increase in extravascular water secondary to elevated pressure in the pulmonary circulation, as in congestive heart failure or intravascular volume overload 3