Kerley Lines in Pulmonary Edema and Interstitial Lung Disease

Overview of Kerley Lines

The European Society of Cardiology recommends that chest X-ray findings of Kerley B lines, combined with pulmonary venous congestion, interstitial edema, and pleural effusions, confirm pulmonary congestion from elevated left ventricular filling pressures 2
Kerley B lines are particularly associated with mitral stenosis or chronic heart failure 2
Kerley B lines appear on chest X-ray in pulmonary veno-occlusive disease along with peripheral interstitial infiltrates 1

The European Society of Cardiology recommends measuring plasma natriuretic peptides (BNP or NT-proBNP) using point-of-care assay to differentiate acute heart failure from non-cardiac causes 2
Lung ultrasound should be used as the first-line diagnostic approach for suspected interstitial syndrome, as it may lead to better patient outcomes compared to conventional chest radiography 3, 2
B-lines on ultrasound are the sonographic equivalent of Kerley lines, representing interstitial thickening 3, 4

Administer intravenous loop diuretics (furosemide) as first-line treatment when Kerley lines indicate acute pulmonary congestion 2
Provide oxygen therapy if SpO₂ <90% 2
Consider intravenous nitroglycerin if systolic BP >100 mmHg to reduce preload and afterload 2