Acute respiratory distress syndrome (ARDS)

Case contributed by Frank Gaillard


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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