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Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Injury: A Comparative CT Study1

Sujal R. Desai, MD, MRCP, FRCR, Athol U. Wells, MD, FRACP, Ganesh Suntharalingam, BA, MB, BChir, FRCA, Michael B. Rubens, DMRD, FRCR, Timothy W. Evans, BSc, MD, PhD, DSc, FRCP and David M. Hansell, MD, FRCP, FRCR

1 From the Department of Radiology (S.R.D., M.B.R., D.M.H.), the Interstitial Lung Disease Unit (A.U.W.), and the Intensive Care Unit (G.S., T.W.E.), Royal Brompton Hospital, Sydney St, London SW3 6NP, England. Received May 11, 2000; revision requested June 19; revision received August 16; accepted September 12. Address correspondence to D.M.H. (e-mail: d.hansell@rbh.nthames.nhs.uk).



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  		Figure 1a. CT images in two patients with extrapulmonary injury demonstrate a typical pattern. (a) CT image (at level 3) obtained 5 days after intubation in a patient with ARDS following abdominal surgery shows that IPOd (x) merges with ground-glass opacification (o) in the nondependent lung. (b) CT image (at level 3) obtained in a patient with ARDS secondary to systemic sepsis (day 3 after intubation) shows less-intense parenchymal opacificaton in dependent lung. There is extensive ground-glass opacification and normally aerated lung parenchyma anteriorly.

 


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  		Figure 1b. CT images in two patients with extrapulmonary injury demonstrate a typical pattern. (a) CT image (at level 3) obtained 5 days after intubation in a patient with ARDS following abdominal surgery shows that IPOd (x) merges with ground-glass opacification (o) in the nondependent lung. (b) CT image (at level 3) obtained in a patient with ARDS secondary to systemic sepsis (day 3 after intubation) shows less-intense parenchymal opacificaton in dependent lung. There is extensive ground-glass opacification and normally aerated lung parenchyma anteriorly.

 


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  		Figure 2a. Atypical CT pattern in two patients with ARDSp following bacterial pneumonia. (a) CT image (at level 3) obtained 6 days after intubation, shows patchy IPOnd (arrows) and ground-glass opacification (arrowhead). (b) CT image obtained 8 days following intubation shows that there are multiple bilateral cystic spaces (arrowheads) in the lower zones (level 5). Focal areas of IPO (arrow) and ground-glass opacification are also depicted.

 


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  		Figure 2b. Atypical CT pattern in two patients with ARDSp following bacterial pneumonia. (a) CT image (at level 3) obtained 6 days after intubation, shows patchy IPOnd (arrows) and ground-glass opacification (arrowhead). (b) CT image obtained 8 days following intubation shows that there are multiple bilateral cystic spaces (arrowheads) in the lower zones (level 5). Focal areas of IPO (arrow) and ground-glass opacification are also depicted.

 




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