Injury edema

The radiographic findings of injury edema are a patchy, often peripheral, pattern of pulmonary opacification, with air bronchograms present and a normal central vascular volume. The radiographic appearance of injury edema often lags the clinical manifestations, and diagnosis of the acute respiratory distress syndrome requires correlation of the clinical findings of severe unrelenting hypoxemia which is refractory to oxygen therapy, with the radiographic appearance of injury edema in an appropriate clinical setting (Fig 4). Accurate interpretation of serial radiographs in the patient with acute respiratory distress syndrome requires a knowledge of the clinical and particularly the ventilatory status in order to differentiate changes in pulmonary aeration due to altered ventilatory support from changes in the underlying state of the injured lung (MNneand Pistojesj 1993.).

Fig. 4 Acute respiratory distress syndrome. This patient experienced acute respiratory failure following a normal vaginal delivery, complicated by a subsequent ruptured appendix. Notice the normal heart and vascular pedicle size, prominent air bronchograms, and extensive bilateral parenchymal opacification with relative sparing of the apices and costophrenic angles.

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