A 59-year-old woman with hypertension and diabetic nephropathy presented with a sudden onset of dyspnea after discontinuing her medications. Physical examination revealed hypertension (blood pressure, 225/122 mm Hg), tachycardia (heart rate, 112 bpm), tachypnea (24 breaths per minute), and hypoxemia (oxygen saturation, 94%, despite treatment with supplemental oxygen). The patient also had elevated jugular venous pressure, bilateral rales, and edema of the legs.The level of brain natriuretic peptide was elevated (780.8 pg per milliliter; normal level, <18.4). A chest radiograph showed an enlarged cardiac silhouette, a dilated azygos vein, and peribronchial cuffing, in addition to Kerley's A, B, and C lines.
Kerley's A lines (arrows) are linear opacities extending from the periphery to the hila; they are caused by distention of anastomotic channels between peripheral and central lymphatics.
Kerley's B lines (white arrowheads) are short horizontal lines situated perpendicularly to the pleural surfaceat the lung base; they represent edema of the interlobular septa.
Kerley's C lines (black arrowheads) are reticular opacities at the lung base, representing Kerley's B linesenface. These radiologic signs and physical findings suggest cardiogenic pulmonary edema. The patient's condition improved on treatment with diuretics and vasodilators.
Kerley D lines are wxactly the same as kerley B lines except that they are seen on lateral chest radiographs in the retrosternal air gap.
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