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Adult Respiratory Distress Syndrome Due to Pulmonary and Extrapulmonary Causes: CT, Clinical, and Functional Correlations¹

¹ From the Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226-3596 (L.R.G.); the Departments of Anesthesia and Intensive Care (L.R.G., R.F., P.T., A.P.) and Radiology (M.T.), and the Institute of Biomedical Sciences (M.F.), University of Milan, Monza, Italy; and the Department of Anaesthesia and Intensive Care, Ospedale Maggiore Di Milano IRCCS, Milan, Italy (L.G.). Received October 23, 1998; revision requested January 5, 1999; revision received February 16; accepted June 8. Address reprint requests to L.R.G.

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.

Index terms: Computed tomography (CT), helical, 60.12115 • Lung, consolidation • Lung, CT, 60.12111, 60.12115 • Lung, diseases, 60.21, 60.413 • Respiratory distress syndrome, adult (ARDS), 60.413

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