Kerley lines are a sign seen on chest radiographs with interstitial pulmonary edema.

They are thin linear pulmonary opacities caused by fluid or cellular infiltration into the interstitium of the lungs. They are named after Peter Kerley. They are suggestive for the diagnosis of congestive heart failure, but are also seen in various non-cardiac conditions such as pulmonary fibrosis, interstitial deposition of heavy metal particles or carcinomatosis of the lung. Chronic Kerley B lines may be caused by fibrosis or hemosiderin deposition caused by recurrent pulmonary oedema. Kerley A lines : These are longer (at least 2cm and up to 6cm) unbranching lines coursing diagonally from the hila out to the periphery of the lungs. They are caused by distension of anastomotic channels between peripheral and central lymphatics 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 B lines : 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. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at thecostophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs. Kerley B lines are seen in Congestive Heart Failure (CHF) and Interstitial Lung Diseases (ILD). Kerley C lines : These are the least commonly seen of the Kerley lines. They are short, fine lines throughout the lungs, with a reticular appearance. They may represent thickening of anastomotic lymphatics or superimposition of many Kerley B lines.

A 59-year-old woman with hypertension and diabetic nephropathy presented with a sudden onset of dyspnea after discontinuing her medications. Physical examination revealed hypertension (blood pressure, 225/122 mm Hg), tachycardia (heart rate, 112 bpm), tachypnea (24 breaths per minute), and hypoxemia (oxygen saturation, 94%, despite treatment with supplemental oxygen). The patient also had elevated jugular venous pressure, bilateral rales, and edema of the legs. The level of brain natriuretic peptide was elevated (780.8 pg per milliliter; normal level, <18.4). A chest radiograph showed an enlarged cardiac silhouette, a dilated azygos vein, and peribronchial cuffing, In addition to Kerley's A, B, and C lines. Kerley's A lines (arrows) are linear opacities extending from the periphery to the hila; they are caused by distention of anastomotic channels between peripheral and central lymphatics. Kerley's B lines (white arrowheads) are short horizontal lines situated perpendicularly to the pleural surface at the lung base; they represent edema of the interlobular septa. Kerley's C lines (black arrowheads) are reticular opacities at the lung base, representing Kerley's B lines en face.

These radiologic signs and physical findings suggest cardiogenic pulmonary edema. The patient's condition improved on treatment with diuretics and vasodilators. Edema ini menimbulkan septal lines yang dikenal sebagai Kerleys lines,yang ada 4 jenis, yaitu: Kerley A: garis panjang di lobus superior paru, berasal dari daerah hilus menuju ke atas dan perifer. Kerley B: garis-garis pendek dengan arah horizontal tegak lurus pada dinding pleura dan letaknya di lobus

inferior, paling mudah terlihat karena letaknya tepat di atas sinus costophrenicus. Garis ini adalah yang paling mudah ditemukan pada keadaan gagal jantung. Kerley C: garis-garis pendek, bercabang, ada di lobus inferior. Perlu pengalaman untuk melihatnya, karena hampir sama dengan pembuluh darah. Kerley D: garis-garis pendek, horizontal, letaknya retrosternal. Hanya tampak pada foto lateral.