Radiographic pulmonary congestion in end-stage congestive heart failure

Chest radiography is considered an accurate technique for evaluating the presence and degree of congestive heart failure 1 (CHF). Radiographic evidence of redistribution of pulmonary blood flow and interstitial and alveolar edema is an established indicator of pulmonary artery wedge pressure in both acute and chronic forms of CHF. 2 It is believed that the absence of these radiographic findings is inconsistent with severe CHF and, specifically, elevations of pulmonary artery wedge pressure. 3–5 Much work describing the utility of chest radiography in the diagnosis and management of patients with CHF was carried out before the advent of potent diuretics and vasodilator agents. 6 Currently, many treated patients with end-stage CHF do not have clinical congestion and may die suddenly despite apparent hemodynamic compensation. 7,8 This report examines the chest radiographic abnormalities observed in patients with chronic severe CHF and marked elevation of pulmonary artery wedge pressure