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This is a case of a 47-year-old gentleman

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presented to the ED with shortness of breath.

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He did not have any fever, denied any cough.

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And so again, we were able to obtain a portable x-ray.

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And let's go through this in our standard approach.

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So here we just have lots of overlying monitoring wires.

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We see that there's median sternotomy wires, which are intact.

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Looking at the lungs in the left side,

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what we can see is that there's indistinctness of the pulmonary vasculature,

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and really kind of this interstitial prominence that we see through here.

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So normally, we should be able to see branching and arborizing vessels.

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It's a little bit hard to see because

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of all the generalized haziness that's there. No large effusions.

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We don't see any pneumothorax. On the right side,

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very similar conversation, no pneumothorax or large pleural effusion.

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But we do see increased haziness and intercessional prominence throughout

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with indistinctness, again, of the pulmonary vasculature.

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So this is a patient who, again, we think about what could be going on.

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Could this be something that's like an atypical viral infection?

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Could this be pulmonary edema?

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While we don't have large effusions,

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we do, as we're kind of going through our checklist, looking at the cardiomediastinal

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silhouette, the heart is enlarged, the airway is midline,

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and it does look like there may be a valve that's sitting here as well,

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which may explain part of why the heart is just so enlarged.

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So looking at this together with the patient's history,

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so there's no evidence of fever, the patient is just short of breath.

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This could represent a patient

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with pulmonary edema, and sometimes it can be hard to distinguish that, you know,

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is this pulmonary edema within the setting of a complete, you know, big heart and edematous

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lungs with pleural effusion, big CHF picture?

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Or is this somewhere along the spectrum?

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So this case does not have large effusion, but the heart is big and the lungs do look

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like they're congested and have pulmonary edema.

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So this is an example of pulmonary edema.

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Keep in mind that sometimes the clinical history is also helpful.

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So understanding whether or not there's

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anything that looks like signs and symptoms of infection,

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because sometimes atypical infection can have a very similar appearance, and being

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able to differentiate those two based upon the information is helpful.