What chest imaging finding is most likely in cardiogenic shock with pulmonary edema?

What chest imaging finding is most likely in cardiogenic shock with pulmonary edema?

• A. Clear lungs
• B. Large pleural effusions
• C. Cardiomegaly with interstitial/alveolar edema
• D. Pneumothorax

Answer: (C)

In cardiogenic shock, the failing heart can't pump effectively, causing back pressure into the pulmonary circulation. That elevated left-sided filling pressure drives fluid from capillaries into the lung interstitium and airspaces, producing edema on chest imaging. The most characteristic pattern is an enlarged cardiac silhouette (cardiomegaly) with interstitial edema that can progress to alveolar edema, often with central or perihilar prominence and possible small pleural effusions. This combination reflects the congestive nature of the edema driven by pump failure.

A clear lung would not fit edema from cardiogenic shock, and pneumothorax is unrelated to pulmonary edema. Large pleural effusions can occur but the key finding here is the enlarged heart with edema in the lungs.