Acute Phase
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 –
Diffuse Ground Glass Pattern
Ashley Davidoff TheCommonVein.net 117653
Patchy Diffuse Ground Glass Pattern
Dominant – Central Location
Relative Lower Lobes and Subpleural Sparing
Ashley Davidoff TheCommonVein.net 134304
Patchy Diffuse Ground Glass Pattern and right pleural effusion
Ashley Davidoff TheCommonVein.net 134300
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
Patchy Diffuse Ground Glass Pattern, thickened interlobular septa
Subpleural Sparing
Ashley Davidoff TheCommonVein.net 134294
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
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
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
Diffuse Ground Glass Pattern and A-P gradient
Ashley Davidoff TheCommonVein.net 134245
Subacute and Chronic Phases Traction Bronchiectasis
Diffuse Ground Glass Pattern with Mild Traction Bronchiectasis
Ashley Davidoff TheCommonVein.net 134262