肺水腫(pulmonary edema, Kerley's A, B, and C Lines)

上圖是一位患者原先每週洗一次腎一陣子後，因為呼吸喘所照的胸部X光。

書上常提的肺水腫胸部X光片，常可看見Kerley's A, B, C lines。正好可以印証在這患者的檢查結果上（參考資料NEJM 360;15; april 9, 2009)。

Kerley's A line. 就是由垂直肺周邊、朝著hilar的、大約是2cm的線。

These are longer (at least 2cm) unbranching lines coursing diagonally from the periphery toward the hila in the inner half of the lungs. Kerley A lines are less commonly seen than Kerley B lines. Kerley A lines are never seen without Kerley B or C lines also present.

Kerley's b line. 即是肺周邊、水平的短線（常短於1cm）。

These are short parallel lines at the lung periphery. These lines represent interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the pleura. Kerley B lines are seen in Congestive Heart Failure (CHF) and Interstitial Lung Diseases (ILD).

Kerley's c line.最不常見的線，短、細，朝著橫隔。

These are the least commonly seen of the Kerley lines. They are short, fine lines.

常見的順序：Kerley's B > A > C 。下圖是NEJM的例圖。

以上這些線條是代表心因性肺水腫。

在本文的這患者，因為她的餘尿量無法排洩掉日常的水份攝取，所以導致肺水腫。在我們增加透析次數為每週二次後，症狀逐漸改善。在洗腎的患者，充足的透析次數和劑量是很重要的，足量的透析才能真的給予腎友安全和穩定的生活。