Newell J D, Underwood G H, Kelley M J
Cardiol Clin. 1983 Nov;1(4):729-43.
We have discussed several diseases that diffusely affect the pulmonary parenchyma. The diagnostic problem is to separate cardiac pulmonary edema from noncardiac pulmonary edema, diffuse interstitial fibrosis, and lymphangitic spread of carcinoma. Frequently, this may not be possible by radiographic means alone, and additional historic and physiologic information must be obtained. It is also important to know that cardiac pulmonary edema may present in a focal or regional distribution in patients with chronic obstructive pulmonary disease. Several additional radiographic tests may be used to evaluate abnormal pulmonary parenchymal densities seen on the portable chest radiograph, when the differential diagnosis includes increased extravascular water, pneumonia, and pulmonary fibrosis. The easiest of these tests to perform is the gravitational shift test.
我们已经讨论了几种弥漫性累及肺实质的疾病。诊断的问题在于区分心源性肺水肿与非心源性肺水肿、弥漫性间质纤维化以及癌性淋巴管播散。通常，仅通过影像学手段可能无法做到这一点，还必须获取更多的病史和生理学信息。同样重要的是要知道，在慢性阻塞性肺疾病患者中，心源性肺水肿可能呈局灶性或区域性分布。当鉴别诊断包括血管外水分增加、肺炎和肺纤维化时，可使用几种额外的影像学检查来评估便携式胸部X线片上所见的异常肺实质密度。这些检查中最容易实施的是重力移位试验。
