Thoracic Imaging

Adult Respiratory Distress Syndrome Due to Pulmonary and Extrapulmonary Causes: CT, Clinical, and Functional Correlations

Published Online:Nov 1 1999https://doi.org/10.1148/radiology.213.2.r99nv42545

Abstract

PURPOSE: To assess the differences in CT appearance between adult respiratory distress syndrome due to pulmonary disease (ARDS_P) and that due to extrapulmonary disease (ARDS_EXP) and determine whether the variable appearances of ARDS are due, in part, to the initial pulmonary and systemic causes.

MATERIALS AND METHODS: Thirty-three patients, 22 with ARDS_P and 11 with ARDS_EXP, underwent helical CT shortly after intubation. Two readers evaluated images for the type, extent, and distribution of pulmonary opacities; secondary findings; and correlation with survival and physiologic parameters.

RESULTS: In both ARDS_P and ARDS_EXP, approximately 80% of the lung was abnormal. In ARDS_P, ground-glass opacification and consolidation were equally prevalent, whereas in ARDS_EXP ground-glass opacification was dominant. Ground-glass opacification was evenly distributed, whereas consolidation tended to be dorsal and caudal. ARDS_P often caused asymmetric consolidation, whereas ARDS_EXP caused symmetric ground-glass opacification. Air bronchograms were almost universal. Pleural effusions were present in one-half of the patients, and Kerley B lines and pneumatoceles were uncommon. Lung consolidation correlated with the ratio of mean partial pressure of arterial oxygen to fraction of inspired oxygen, shunt fraction, and pulmonary arterial pressure. The patients who died tended to have more consolidation and asymmetric disease.

CONCLUSION: ARDS_P tends to be asymmetric, with a mix of consolidation and ground-glass opacification, whereas ARDS_EXP has predominantly symmetric ground-glass opacification. In both groups, pleural effusions and air bronchograms are common, and Kerley B lines and pneumatoceles are uncommon.

References

1 Bombino M, Gattinoni L, Pesenti A, et al. The value of portable chest roentgenography in adult respiratory distress syndrome: comparison with computed tomography. Chest 1991; 100:762-769. Crossref, Medline, Google Scholar
2 Goodman LR. Congestive heart failure and adult respiratory distress syndrome: new insights using computed tomography. Radiol Clin North Am 1996; 34:33-46. Medline, Google Scholar
3 Greene R. Adult respiratory distress syndrome: acute alveolar damage. Radiology 1987; 163:57-66. Link, Google Scholar
4 Greene R, Putman CE, Goodman LR. Regional distribution of lung derangement in the adult respiratory distress syndrome. In: Potchen EJ, Grainger RG, Greene R, eds. Pulmonary radiology. Philadelphia, Pa: Saunders, 1993; 179-190. Google Scholar
5 Joffe N. The adult respiratory distress syndrome. AJR 1974; 122:719-731. Crossref, Google Scholar
6 Johnson KS, Bishop MH, Stephen CM, II. Temporal patterns of radiographic infiltration in severely traumatized patients with and without adult respiratory distress syndrome. J Trauma 1994; 36:644-650. Crossref, Medline, Google Scholar
7 Milne EN, Pistolesi M. Differentiating increased pressure from injury pulmonary edema In: Reading the chest radiograph: a physiologic approach. St Louis, Mo: Mosby-Year Book, 1993; 242-266. Google Scholar
8 Miniati M, Pistolesi M, Paoletti P, et al. Objective radiographic criteria to differentiate cardiac, renal, and injury lung edema. Invest Radiol 1988; 23:433-440. Crossref, Medline, Google Scholar
9 Putman CE. Cardiac and noncardiac edema: radiologic approach. In: Goodman LR, Putman CE, eds. Critical care imaging. 3rd ed. Philadelphia, Pa: Saunders, 1992; 107-127. Google Scholar
10 Stark P, Greene R, Kott MM, et al. CT-findings in ARDS. Radiologie 1987; 27:367-369. Google Scholar
11 Tagliabue M, Casella TC, Zincone GE, et al. CT and chest radiography in the evaluation of adult respiratory distress syndrome. Acta Radiol 1994; 35:230-234. Crossref, Medline, Google Scholar
12 Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Am J Respir Crit Care Med 1994; 149:818-824. Crossref, Medline, Google Scholar
13 Murray JR. The adult respiratory distress syndrome (may it rest in peace) (editorial). Am Rev Resp Dis 1975; 111:716-718. Medline, Google Scholar
14 Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988; 138:720-723. Crossref, Medline, Google Scholar
15 Petty TL. The adult respiratory distress syndrome (confessions of a “lumper”). Am Rev Resp Dis 1975; 111:713-715. Medline, Google Scholar
16 Gattinoni L, Pelosi P, Suter PM, et al. Acute respiratory distress syndrome due to pulmonary and extrapulmonary disease: different syndromes?. Am J Respir Crit Care Med 1998; 158:3-11. Crossref, Medline, Google Scholar
17 Gattinoni L, Bombino M, Pelosi P, et al. Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 1994; 271:1772-1779. Crossref, Medline, Google Scholar
18 Owens CM, Evans TW, Keogh BF, et al. Computed tomography in established adult respiratory distress syndrome: correlation with lung injury score. Chest 1994; 106:1815-1821. Crossref, Medline, Google Scholar
19 Bone RC. An early test of survival in patients with adult respiratory distress syndrome: the Pao₂/Fio₂ ratio and its differential response to conventional therapy—Prostaglandin E1 Study Group. Chest 1989; 96:849-852. Crossref, Medline, Google Scholar
20 Randes RH, Wolfe DA. Introduction to the theory of nonparametric statistics New York, NY: Wiley, 1979. Google Scholar
21 Terashima T, Matsubara H, Nakamura M, et al. Local Pseudomonas instillation induces contralateral injury and plasma cytokines. Am J Respir Crit Care Med 1996; 153:1600-1605. Crossref, Medline, Google Scholar
22 Gattinoni L, D'Andrea L, Pelosi P, et al. Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA 1993; 269:2122-2127. Crossref, Medline, Google Scholar
23 Winer-Muram HT. Ventilator-associated pneumonia in patients with adult respiratory distress syndrome: CT evaluation. Radiology 1998; 208:193-199. Link, Google Scholar
24 Langer M, Mascheroni D, Marcolin R. The prone position in ARDS patients: a clinical study. Chest 1988; 94:103-107. Crossref, Medline, Google Scholar
25 Pelosi P, Tubiolo D, Mascheroni D, et al. Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med 1998; 157:387-393. Crossref, Medline, Google Scholar
26 Ruskin JA, Gurney JW, Thorsen MK, Goodman LR. Detection of pleural effusions on supine chest radiographs. AJR 1987; 148:681-683. Crossref, Medline, Google Scholar
27 Webb W, Müller N, Naidich D. High-resolution CT of the lung Philadelphia, Pa: Lippincott-Raven, 1996; 28-31. Google Scholar
28 Storto M, Kee S, Golden J, Webb WR. Hydrostatic pulmonary edema: high-resolution CT findings. AJR 1995; 165:817-820. Crossref, Medline, Google Scholar
29 Herold CJ, Wetzel RC, Robotham JL, et al. Acute effects of increased intravascular volume and hypoxia on the pulmonary circulation: assessment with high-resolution CT. Radiology 1992; 183:655-664. Link, Google Scholar
30 Gattinoni L, Pesenti A, Bombino M, et al. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 1988; 69:824-832. Crossref, Medline, Google Scholar
31 Maunder RJ, Shuman WP, McHugh JW, et al. Preservation of normal lung regions in the adult respiratory distress syndrome: analysis by computed tomography. JAMA 1986; 255:2463-2465. Crossref, Medline, Google Scholar
32 Tagliabue P, Giannatelli F, Vedovati S, et al. Lung CT scan in ARDS: are three sections representative of the entire lung?. Intensive Care Med 1998; 24(suppl 1):93. Crossref, Medline, Google Scholar

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Published in print: Nov 1999

Vol. 213, No. 2

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