Cardiac Radiography > Pathology > Pulmonary Vascular Patterns > Pulmonary Venous Hypertension


Pulmonary Vascular Patterns: Pulmonary Venous Hypertension

Pulmonary venous hypertension (PVH) results from an increase in pressure in the pulmonary veins, usually as a result of left atrial hypertension. This is measured clinically as an increase in the pulmonary capillary wedge pressure (PCWP) over the normal 12 to 14 mmHg.

Mild elevation of the PCWP results in redistribution of the pulmonary blood flow to the non-dependent lung zones:

Redistribution of blood flow to the upper lung zones results in abnormal enlargement of the upper lobe vessels. 

 

As the pressure approaches 20 mmHg, interstitial edema develops:

Interstitial edema with indistinct vessels and thickened interlobular septa (Kerley B lines) 

 

Pressures in the mid 20s typically cause alveolar edema:

Airspace edema with confluent airspace opacities in both lungs. 

 

Common causes of PVH are obstruction to LV inflow, LV systolic dysfunction, severe mitral regurgitation, and acute pulmonary and systemic volume overload. The radiographic appearance of the stages of PVH are shown in the radiographs above.

 

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