Oedema and fibrosis of the lungs in left ventricular failure

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Abstract
The radiological and pathological changes in the lungs in left ventricular failure are considered in detail. Pathologically, there may be interstitial edema, fibrinous and non-fibrinous intra-alveolar edema, fibrosis, infarcts, hemorrhages, siderophages, and metastatic calcification (with renal failure). Some of these changes can be demonstrated radiologically. Interstitial edema causes peripheral septal lines, long septal lines, perihilar haze, and peribronchial and perivascular cuffing. Fibrinous intra-alveolar edema causes transient episodes of uncharacteristic shadowing frequently changing in shape and distribution. Occasionally it is bat''s-wing in pattern, with or without uremia. Non-fibrinous edema probably contributes to shadows, but much of that found pathologically is regarded as terminal. Chest radiographs are not affected by fibrosis or siderophages. Fibrosis is intra-alveolar and is due to organization of fibrinous edema. Commonly this process is present in different stages in the same histological section. Several successive attacks may leave their mark, and particular attacks seen radiologically can be correlated with histological lesions of appropriate ages. Since the radiographs commonly clear between episodes of shadowing, fibrosis does not appear to affect radiographs. Enormous numbers of siderophages are present in alveoli frequently and the total bulk must be considerable, but their presence cannot be detected radiologically. All these changes may affect the function of the lungs inleft ventricular failure. While chest radiographs are a valuable guide to some of them, normal films do not exclude intra-alveolar fibrosis and large collections of siderophages in alveoli.