Presentation
The patient presents with an early hyperacute stroke, with a sudden reduced level of consciousness, and is intubated.
Patient Data
The patient is intubated with the ETT at the carina.This should be retracted. There is minimal left-sided proximal tracheal deviation. There is a normal cardiomediastinal contour. There are overlying ECG leads.
There is diffuse, bilateral air space opacification, right greater than left, with bi-apical sparing.
Case Discussion
The patient collapsed in the emergency department and was intubated. The portable chest X-ray was performed immediately after the intubation. On review, the presenting history was an acute severe headache, and vertigo, for investigation.
MRI brain (rID 165784) confirmed extensive early hyperacute posterior circulatory non-haemorrhagic infarction.
There is a wide differential diagnosis for the above chest X-ray appearance including infection, ARDS, pulmonary oedema, pulmonary haemorrhage and aspiration pneumonitis. In this instance, based on the acute presentation, negative past and recent medical history, absence of any causative incidents and the ease and rapidity of intubation suggested a non-cardiogenic aetiology and specifically likely acute neurogenic pulmonary oedema (within 4 hours of the neurological event).
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