This 65 year-old male patient with necrotising fasciitis, septic shock and acute renal failure had progressive respiratory failure requiring ventilation. The CXR above shows multifocal bilateral air-space opacities, in a predominantly perihilar and lower zone distribution. This is a characteristic appearance of ARDS in the appropriate clinical context. The differential diagnosis includes infection (also a common complication of ARDS), and cardiogenic pulmonary edema. Differentiation can be impossible in some cases.

The causes of ARDS include: trauma; septicaemia; hypovolaemic shock; fat embolism; near-drowning; burns; viral pneumonia; pancreatitis; oxygen toxicity; and disseminated intravascular coagulopathy. ARDS mortality is high, around 50%, and many survivors develop chronic lung disease, with damaged lung healing by fibrosis. A minority recover fully.

Reference: Sutton D. Textbook of Radiology and Imaging 6th edition. Churchill Livingstone 1998

Credit: Dr Laughlin Dawes