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Media Gallery

Medium-power photomicrograph (original magnification, X10; hematoxylin and eosin stain) demonstrates a fibrotic interlobular septum containing a vein with an occluded lumen (arrowhead). The occlusion is composed of dense, collagen-rich, fibrous tissue. Image courtesy of Thoracic Imaging Section, Department of Radiologic Pathology, Armed Forces Institute of Pathology.
Pulmonary veno-occlusive disease in a 43-year-old man. An axial computed tomography (CT) scan (lung window level) shows multiple septal lines (arrowhead) and a dilated central pulmonary artery (arrow). Image courtesy of Thoracic Imaging Section, Department of Radiologic Pathology, Armed Forces Institute of Pathology.

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Table. Distinguishing Pulmonary Edema From PVOD Based on Radiographic, Echocardiographic, and Heart Catheterization Data

Table. Distinguishing Pulmonary Edema From PVOD Based on Radiographic, Echocardiographic, and Heart Catheterization Data

Features	Pulmonary Edema	PVOD
Chest radiograph
Kerley B lines	Present	Present
Pleural effusion	Usually present	May be present
Enlarged cardiac silhouette	Present	Less prominent
Enlarged pulmonary artery	Present	Present
Chest CT scan
Thickened septae	Present	Present
Pleural effusion	Usually present	May be present
Enlarged heart	Present	Less prominent
Enlarged pulmonary artery	Present	Present
Septal concavity into left ventricle	Absent	Present
Echocardiogram
Pulmonary artery systolic pressure	Elevated (usually not >80 mm Hg)	Elevated (may be >80 mm Hg)
Left atrial enlargement	Present	Absent
Right atrial enlargement	Present	Present
Right ventricular hypertrophy	Absent	Present
Paradoxical septal motion	Absent	Present
Large pericardial effusion	Absent	May be present
Right-sided heart catheterization
Pulmonary vascular resistance	Below 3.0 Wood units	Above 3.0 Wood units
Pulmonary capillary wedge pressure	Above 18 mm Hg	Usually below 15 mm Hg (if catheter is properly wedged)
Mean pulmonary artery pressure	Elevated (almost never >50 mm Hg)	Elevated (may be >50 mm Hg)
Cardiac output	May be normal, low, or high	Mostly decreased, may be low normal
Oxyhemoglobin step-up	Absent	Absent

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Author

Hakim Azfar Ali, MD Consultant in Pulmonary and Critical Care Medicine, Christiana Care Hospital

Hakim Azfar Ali, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Shoaib Alam, MD Staff Clinician, Pulmonary and Vascular Medicine, National Heart, Lung, and Blood Institute, National Institutes of Health

Shoaib Alam, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine, International Society for Magnetic Resonance in Medicine, European Respiratory Society, Pennsylvania Thoracic Society

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Acknowledgements

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP Professor of Genomics and Personalized Medicine Research, Internal Medicine, and Pediatrics, Associate Director, Center for Genomics and Personalized Medicine Research, Director of Research, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi

Disclosure: See below for list of all activities None None

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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