Fast Five Quiz: Acute Respiratory Distress Syndrome (ARDS)

Zab Mosenifar, MD


April 10, 2020

ARDS is defined by the presence of bilateral pulmonary infiltrates. The infiltrates may be diffuse and symmetric or asymmetric, especially if superimposed upon preexisting lung disease or if the insult causing ARDS was a pulmonary process, such as aspiration or lung contusion. The pulmonary infiltrates usually evolve rapidly, with maximal severity within the first 3 days. Infiltrates can be noted on chest radiographs almost immediately after the onset of gas exchange abnormalities. They may be interstitial, characterized by alveolar filling, or both. Initially, the infiltrates may have a patchy peripheral distribution, but soon they progress to diffuse bilateral involvement with ground glass changes or frank alveolar infiltrates.

In general, clinical evaluation and routine chest radiography are sufficient in patients with ARDS. However, CT may be indicated in some situations. CT is more sensitive than plain chest radiography in detecting pulmonary interstitial emphysema, pneumothoraces and pneumomediastinum, pleural effusions, cavitation, and mediastinal lymphadenopathy.

As part of the workup, patients with ARDS should undergo two-dimensional echocardiography for the purpose of screening. If findings are suggestive of patent foramen ovale shunting, two-dimensional echocardiography should be followed up with transesophageal echocardiography.

Read more about the workup of ARDS.


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