Medicine of the Future in America

Computed Tomography in Established Adult Respiratory Distress Syndrome: Results

Computed Tomography in Established Adult Respiratory Distress Syndrome: ResultsComputed tomographic abnormalities identified on the initial and follow-up scans are summarized in Tables 2 and 3. The presence or absence of the five categories of disease was recorded for the initial scan. These were ground-glass opacification (8/8), parenchymal distortion (8/8), multifocal areas of consolidation (6/8), reticular opacities (6/8), and linear opacities (5/8). Bilateral pleural effusions were present in two patients and unilateral effusions were present in three. Small, shallow, bilateral anterior pneumothoraces were present in two patients and unilateral pneumothoraces were present in three. On the subsequent CT scans, the multifocal areas of consolidation had resolved in all cases. Ground-glass opacification persisted in four of eight (Fig 1), although the extent and severity was less marked than in the acute phase.

The reticular pattern resolved completely in one patient, partially resolved in one, persisted unchanged in four of eight, and became more extensive in two of eight patients. The persistent reticular pattern, reflecting interstitial fibrosis, was most pronounced in areas that had previously been densely consolidated (Fig 2). Linear opacities persisted unchanged in four of eight patients, developed in three of eight, and resolved completely in one patient. Lung distortion, shown by bronchial dilation and distortion, was present to some extent in all patients on the initial scan and persisted unchanged in six of eight patients (Fig 3). There was partial resolution of dilated subsegmental bronchi in one patient and features suggestive of progression of emphysema in one nonsmoking patient. Two patients have subsequently developed clinical bronchiectasis, and two other patients had unequivocal evidence of emphysema on follow-up CT scans. antibiotics online

Table 2—Pulmonary Abnormalities Recorded on Initial CT Scan

CaseNo. Ground-GlassOpacification Areas of Consolidation Reticular Opacities LinearOpacities ParenchymalDistortion %Abnormal Lung
1 U-P M-A+P U-P None M-A+P 84
M-A+P L-A+P M-A+P L-A+P
L-A+P L-A+P
2 All zones All zones, sparing lung periphery None None M-A+PL-A+P 86
3 All zones None All zones L-P All zones 93
4 U-A+P L-A+P M-PL-P L-P M-A+PL-A+P 66
5 All zones None All zones L-A+P All zones(emphysema) 60
6 M-A+PL-A+P None None r1> All zones(emphysema) 53
7 All zones All zones U-A+PM-A+P None All zones 86
8 All zones All zones U-AM-AL-A+P U-AM-PL-A+P All zones 87

Table 3—Pulmonary Abnormalities Recorded on Follotv-up CT Scan

PatientNo. Ground-GlassOpacification Areas of Consolidation Reticular Opacities LinearOpacities ParenchymalDistortion %Abnormal Lung
1 U-PM-A+P None All zones U-PM-A+PL-A+P U-PM-A+PL-A+P 66
2 None None U-AM-AL-A None M-AL-A 8
3 U-A, M-A, L-A+P Intralobular fibrosis None All zones more extensive than acute phase L-P All zones 43
4 None None All zones M-A+PL-A+P All zones(emphysema) 20
5 M-A+PL-A+P None All zones due to emphysema L-A+P All zones(emphysema) 58
6 None None None L-A All zones 0
7 None None U-A+PM-AL-A U-A+PM-A All zones 18
8 L-P None All zones U-AM-PL-A+P All zones 63

Figure-1

Figure 1. Patient 5. Top, Dense consolidation in the left lower lobe with patchy areas of ground-glass opacification bilaterally. Moderate-sized left pleural effusion. Bottom, Follow-up CT 13 days later; persistent areas of ground-glass opacification. Complete resolution of the consolidation and pleural effusion.

Figure-2

Figure 2. Patient 7. Top, Multifocal areas of consolidation in the upper lobes. A right pleural effusion is partially responsible for the opacification in the posterior part of the right hemithorax. Bottom, Follow-up CT scan 5 months later; a reticular and linear pattern is seen in areas where the consolidation has resolved.

Figure-3

Figure 3. Patient 1. CT scan 4 months after the precipitating insult showing distortion and dilation of segmental and subsegmental bronchi in the lower lobes in association with a widespread reticular pattern consistent with established interstitial fibrosis.

This entry was posted in ARDS and tagged acute lung injury, adult respiratory distress syndrome, computed tomography.
Copyright © 2012 Medicine of the Future in America www.perfexis.org