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Cardiogenic pulmonary oedema on CT — SCE Respiratory MCQ

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HardThoracic ImagingCardiogenic pulmonary oedema on CTSCE Respiratory

A 53-year-old woman has progressive breathlessness and anaemia. CTPA performed for suspected PE shows no embolus but demonstrates diffuse bilateral smooth interlobular septal thickening, small pleural effusions and cardiomegaly. BNP is elevated. What is the most likely diagnosis?

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Correct answer: C — Cardiogenic pulmonary oedema

The best answer is “Cardiogenic pulmonary oedema”. The clinical pattern, physiology and imaging described are most consistent with Cardiogenic pulmonary oedema. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Lymphangitic carcinomatosis, after safety review”, “Hypersensitivity pneumonitis, after specialist assessment”, “Pulmonary Langerhans cell histiocytosis”, “Pulmonary alveolar proteinosis, after safety review”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1