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RADIOLOKSABHA

ARDS (acute respiratory distress syndrome)

By Dr.Pavan Kumar In RESPIRATORY Posted September 23, 2018

Patient History : A 14yr old boy has complains of intermittent high grade fever, cough and bodyache for 6days, which has progressed to respiratory distress in the previous 24hours. The boy had to be put on ventilator, on the day of admission, to maintain adequate oxygenation. On investigations, found to have a positive lepto tridot test. Here is the CXR prior to intubation. What's going on
Gender:Male
Age:14

ARDS (acute respiratory distress syndrome)
Bilateral predominantly peripheral, somewhat asymmetrical consolidation with air-bronchograms.

Here\'s the CXR of the boy after 4days of ventilator therapy,antibiotics and steroids. (dramatic recovery)

DIFFUSE ALVEOLAR CONSOLIDATIONS

1.CARDIOGENIC PULM EDEMA - (elevated pulm capillary wedge pressure,)

cardiomegaly, dilated central pulm vessels, peribronchial cuffing, redistribution of arterial flow to upper half of lung

2.NON CARDIOGENIC PULM EDEMA (normal pulm capillary wedge pressure)

neurogenic (post ictal/raised ICT)
near drowning
aspiration (mendelson syndr)
heroin abuse
radiation pneumonitis
ARDS - multiple diffuse, poorly circumscribed alveolar opacities which progress and become increasingly confluent.

3.FLUID OVERLOAD/RENAL FAILURE - (raised pulm capillary wedge pressure)
hence appearance similar to cardiogenic type, but more central than peripheral, no redistribution of blood supply to upper parts of lung.