Faces of ARDS

Acute Phase

Early Events in the Pathophysiology of the ARDS
The initial injury results in an acute severe inflammatory response consisting hyperemia , edema with migration initially of neutrophils in the first 6-24 hours followed by monocytes (24-48hours). The intra -alveolar macrophages are activated.
Ashley Davidoff
TheCommonVein.net lungs-0691

Diffuse or Patchy Ground Glass Changes –

ARDS  43F
Diffuse Ground Glass Pattern
Ashley Davidoff TheCommonVein.net 117653

 

ARDS from Sepsis  79M
Patchy Diffuse Ground Glass Pattern
Dominant – Central Location
Relative Lower Lobes and Subpleural Sparing
Ashley Davidoff TheCommonVein.net 134304
ARDS from sepsis 79M
Patchy Diffuse Ground Glass Pattern and right pleural effusion
Ashley Davidoff TheCommonVein.net 134300
ARDS
5ARDS
54 year old female with sepsis and acute respiratory distress syndrome.  Coronal CT shows diffuse ground glass changes with subsegmental regions of consolidation.  The posterior aspect of the lungs showed consolidation characteristic of the antero-posterior density gradient of ARDS 
Ashley Davidoff TheCommonVein.net  54-f002 ARDS

Ground Glass with Subpleural Sparing

ARDS from Sepsis  79M
Patchy Diffuse Ground Glass Pattern, thickened interlobular septa
 Subpleural Sparing
Ashley Davidoff TheCommonVein.net 134294
Diffuse Ground Glass Changes and Subpleural Sparing
ARDS Sickle Cell Crisis
The CXR in this 26 year old male in sickle cell crisis shows diffuse and symmetrical ground glass changes with subpleural sparing
Ashley Davidoff TheCommonVein.net b11662-02

 

Anteroposterior Density Gradient

ARDS -Anteroposterior Density Gradient
Since the patient is mostly in a supine position in the ICU setting the disease is distributed based on gravitational forces with the more dense  consolidation in the most dependent regions posteriorly and less dense with ground glass changes anteriorly. Anteriorly more normal or even hyperexpanded lung is present.
Ashley Davidoff TheCommonVein.net  lungs-0786
ARDS -Anteroposterior Density Gradient
A Memory Image for ARDS
The anterior aspect of a CT in axial projection shows AeRation and the posterior aspect shows increase DenSity due to the gravitational effect of the fluid in the lungs
Ashley Davidoff TheCommonVein.net  lungs-0786-01L
ARDS
54 year old female with sepsis and acute respiratory distress syndrome .  Axial CT at the level of the carina shows ground glass changes and bilateral  posterior consolidation reminiscent of an antero-posterior density gradient – a  characteristic radiological finding of ARDS                                                     Ashley Davidoff TheCommonVein.net 54-f003-ARDS
53F ARDS
Diffuse Ground Glass Pattern and A-P gradient
Ashley Davidoff TheCommonVein.net 134245

 

Subacute and Chronic Phases Traction Bronchiectasis

53F ARDS 8 months later
Diffuse Ground Glass Pattern with Mild Traction Bronchiectasis
Ashley Davidoff TheCommonVein.net 134262