Answer

Air space shadowing: adult respiratory distress syndrome (ARDS)

The patient is clearly unwell, is ventilated and has lines including a central venous catheter (CVC) and ECG monitoring. The endotracheal tube and CVC are appropriately sited. The CVC tip should sit in the SVC and not in the right artium. In addition, there is perihilar air space shadowing involving both lungs. The differential diagnosis for such an appearance includes air space filling with infective exudate, oedema fluid, blood and malignant cells. In this situation ARDS, extensive infection or pulmonary haemorrhage seem the most likely. To limit the differential diagnosis further, more clinical information would be necessary. PCWP can be helpful. The diagnosis in the case example above was ARDS. The CT features of ARDS characteristically show dependent consolidation with more anterior ground glass shadowing (Fig. 1.50).

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