In normal chest xrays, the lower zone pulmonary vessels are more prominent than the upper zone vessels. This is due to the effect of gravity resulting in a pressure difference in the pulmonary vasculature of upto 20mmHg between the apex and base of lung, with increased flow to the lower lobe vessels.
In patients with LV failure, the development of post-capillary pulmonary hypertension results in exudation of fluid into the interstitial space resulting in interstitial edema. This fluid compresses the pulmonary blood vessels, decreasing their compliance and interfering with gas exchange. The resultant alveolar hypoxia is a potent stimulator of pulmonary vasoconstriction. Due to dependent position and increased compression by edema fluid, alveolar hypoxia is more in basal regions compared to thex. This results in more vasoconstriction in the basal regions. So, redistribution of pulmonary blood flow occurs towards the apical region.This is called "Cephalization" of pulmonary blood flow.
How compression of the blood vessel only by the interstitial fluid can cause alveolar hypoxia if ventilation is proper?
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