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Pulmonary venous hypertension 

Pulmonary venous hypertension
Pulmonary venous hypertension

Massimo Pistolesi

, and Mariaelena Occhipinti

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date: 27 January 2022

The chest radiograph reflects quite accurately the sequence of lung water accumulation as it may result from conditions of acute and chronic left heart dysfunction leading to pulmonary venous hypertension. Filtration and reabsorption of liquids is a rather dynamic process that occurs in the lung extravascular space, a delicate space working as both a gas and liquid exchanger. Interference of lung liquid accumulation with the gas exchange function is the most relevant clinical consequence of pulmonary venous hypertension. Lymphatics respond slowly to the increased filtration rate secondary to acute pulmonary venous hypertension, whereas the long-standing disequilibrium of liquid exchange in chronic conditions induces several adaptive changes in lung tissue and lymphatics. Thus, there might be lower amounts of lung oedema for the same level of pulmonary venous hypertension in chronic with respect to acute left heart failure conditions. Knowledge of chest radiographic signs of acute and chronic pulmonary venous hypertension allows better understanding of patients’ clinical conditions. Radiographic scoring of pulmonary interstitial oedema and assessment of vascular pedicle width is recommended to determine extravascular lung liquid balance and intravascular volume status in critically ill patients.

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