Acute respiratory distress syndrome (ARDS)

Case contributed by Assoc Prof Frank Gaillard

Presentation

Admitted to ICU with necrotizing fasciitis, septic shock and acute renal failure. Progressive respiratory failure requiring ventilation.

Patient Data

Age: 65 years
Gender: Male

Multifocal bilateral air-space opacities, in a predominantly perihilar and lower zone distribution. 

Case Discussion

This is a characteristic appearance of ARDS in the appropriate clinical context.

The differential diagnosis includes infection (also a common complication of ARDS), and cardiogenic pulmonary edema. Differentiation can be impossible in some cases.

The causes of ARDS include:

  • trauma
  • septicemia
  • hypovolemic shock
  • fat embolism
  • near-drowning
  • burns
  • viral pneumonia
  • pancreatitis
  • oxygen toxicity
  • disseminated intravascular coagulopathy

ARDS mortality is high, around 50%, and many survivors develop chronic lung disease, with damaged lung healing by fibrosis. A minority recover fully.

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