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STAT CXR for Acute Respiratory Distress

STAT CXR for Acute Respiratory Distress. Elizabeth A. Lendermon. Clinical History. 44 yo white female Multiple previous suicide attempts Admitted after ethylene glycol ingestion Initially intubated and mechanically ventilated but extubated and txd to floor on HD#8

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STAT CXR for Acute Respiratory Distress

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  1. STAT CXR for Acute Respiratory Distress Elizabeth A. Lendermon

  2. Clinical History • 44 yo white female • Multiple previous suicide attempts • Admitted after ethylene glycol ingestion • Initially intubated and mechanically ventilated but extubated and txd to floor on HD#8 • ARF 2o to ATN requiring intermittent HD • RLL PNA with blood cultures positive for pansensitive Acinetobacter and Strep. pneumo

  3. Recurrent Respiratory Distress • Course c/b respiratory distress requiring return to MICU and attributed partially to volume overload with plan for aggressive diuresis and pulmonary toilet • 4 days after return to floor, pt. with continued tachypnea and O2 sat of mid 80’s on 100% vapotherm, no breath sounds on right • Differential dx included • PE • Pulmonary edema • Atelectasis

  4. STAT CXR

  5. 2 Days Prior Present

  6. Diagnosis • Atelectasis on right secondary to mucus plugging • On bronchoscopy, mucus plug filling right mainstem bronchus from level of carina and extending into bronchus intermedius • Per report increased bilateral pleural effusions, right greater than left

  7. Radiographic Features of Lung Collapse • Increased opacification of hemithorax in the setting of tracheal/mediastinal deviation toward the opacification • May see hyperinflation of adjacent lobes or elevation/ depression of hilum • RUL> upperward displacement of minor fissure • RML> minor and major fissures displaced toward each other, no mediastinal shift, can lose right heart border • LUL> aortic arch prominent • RLL/LLL> silhouetting of hemidiaphragm

  8. Differential DX • Differential dx of chest opacification includes: • Consolidation • Pulmonary edema • Pleural effusion • Other alveolar filling processes (hemorrhage, ARDS) • Atelectasis • Extrathoracic stuff • Differential dx for this case: • Opacification 20 to new infiltrate or pleural effusion or both • Atelectasis 20 to pleural effusion or mucus plugging

  9. Outcome after Bronchoscopy References: Squire’s Fundamentals of Radiology, Novelline, 1997

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