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STAT CXR for Acute Respiratory Distress Elizabeth A. Lendermon.

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Presentation on theme: "STAT CXR for Acute Respiratory Distress Elizabeth A. Lendermon."— Presentation transcript:

1 STAT CXR for Acute Respiratory Distress Elizabeth A. Lendermon

2 Clinical History 44 yo white female 44 yo white female Multiple previous suicide attempts Multiple previous suicide attempts Admitted after ethylene glycol ingestion Admitted after ethylene glycol ingestion Initially intubated and mechanically ventilated but extubated and txd to floor on HD#8 Initially intubated and mechanically ventilated but extubated and txd to floor on HD#8 ARF 2 o to ATN requiring intermittent HD ARF 2 o to ATN requiring intermittent HD RLL PNA with blood cultures positive for pansensitive Acinetobacter and Strep. pneumo 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 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 O 2 sat of mid 80’s on 100% vapotherm, no breath sounds on right 4 days after return to floor, pt. with continued tachypnea and O 2 sat of mid 80’s on 100% vapotherm, no breath sounds on right Differential dx included Differential dx included –PE –Pulmonary edema –Atelectasis

4 STAT CXR

5 2 Days Prior Present

6 Diagnosis Atelectasis on right secondary to mucus plugging Atelectasis on right secondary to mucus plugging On bronchoscopy, mucus plug filling right mainstem bronchus from level of carina and extending into bronchus intermedius 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 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 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 May see hyperinflation of adjacent lobes or elevation/ depression of hilum RUL> upperward displacement of minor fissure RUL> upperward displacement of minor fissure RML> minor and major fissures displaced toward each other, no mediastinal shift, can lose right heart border RML> minor and major fissures displaced toward each other, no mediastinal shift, can lose right heart border LUL> aortic arch prominent LUL> aortic arch prominent RLL/LLL> silhouetting of hemidiaphragm RLL/LLL> silhouetting of hemidiaphragm

8 Differential DX Differential dx of chest opacification includes: 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: Differential dx for this case: –Opacification 2 0 to new infiltrate or pleural effusion or both –Atelectasis 2 0 to pleural effusion or mucus plugging

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


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