How Good or Bad is AI in Reading an Abnormal CXR

Key Radiographic Features

Feature	Present?	Comment
Heart size / mediastinum	Yes (appears enlarged)	Cardiomegaly can be exaggerated on an AP portable view.
Cephalization (upper-lobe venous engorgement)	Yes	Upper-zone vessels as large as—or larger than—lower-zone vessels; suggests ↑ left-atrial pressure.
Interstitial edema	Yes	Coarse reticular pattern, possible Kerley lines and peribronchial cuffing.
Alveolar edema (“bat-wing” opacities)	Yes	Symmetric perihilar fluffy air-space opacities extending outward.
Pleural effusions	Probable small	Hazy or blunted costophrenic angles.
Lines / devices	Yes	ECG leads and pacing/monitor wires are visible.

Impression

The combination of vascular redistribution, interstitial thickening, symmetric perihilar air-space opacities, and probable small pleural effusions is most consistent with cardiogenic pulmonary edema / pulmonary vascular congestion due to acute de-compensated heart failure.

Caveats & Next Steps

• Always correlate clinically—BNP, bedside lung ultrasound (B-lines vs consolidation), echocardiography, or PA-catheter data help confirm elevated filling pressures.
• If shock, sepsis, or a normal heart size is present, keep ARDS and diffuse pneumonia in the differential.
• Repeat radiographs after aggressive diuresis/vasodilator therapy—rapid clearing within 24–48 hours favors a cardiogenic origin.