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