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Chest
Diagnosis
Interstitial, Diffuse, and Inhalational Lung Disease
Idiopathic Interstitial Lung Diseases
Acute Respiratory Distress Syndrome (ARDS)
Acute Respiratory Distress Syndrome (ARDS)
Julia Alegría, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Acute respiratory distress syndrome (ARDS)

              • Synonyms

                • Adult respiratory distress syndrome

              • Definitions

                • Syndrome of acute respiratory failure caused by non-cardiogenic pulmonary edema.
                • Berlin criteria
                  • Onset within 1 week of clinical insult or new/worsening respiratory symptoms
                  • Chest radiography: Bilateral opacities (not explained by pleural effusion, lobar/lung collapse, or nodules)
                  • PF ratio < 300 mm Hg with minimum of 5-cm H20 positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP)
                    • PaO₂:FiO₂ = PF ratio: Ratio of arterial oxygen tension to fraction of inspired oxygen
                  • Respiratory failure not fully explained by cardiac failure/fluid overload

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    Selected References

                                    1. Tsuchiya N et al: Imaging findings of pulmonary edema: part 1. Cardiogenic pulmonary edema and acute respiratory distress syndrome. Acta Radiol. 61(2):184-94, 2020
                                    2. Huppert LA et al: Pathogenesis of acute respiratory distress syndrome. Semin Respir Crit Care Med. 40(1):31-9, 2019
                                    3. Reilly JP et al: Acute respiratory distress syndrome phenotypes. Semin Respir Crit Care Med. 40(1):19-30, 2019
                                    4. ARDS Definition Task Force et al: Acute respiratory distress syndrome: the Berlin Definition. JAMA. 307(23):2526-33, 2012
                                    5. Desai SR et al: Acute respiratory distress syndrome caused by pulmonary and extrapulmonary injury: a comparative CT study. Radiology. 218(3):689-93, 2001
                                    6. Puybasset L et al: Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT Scan ARDS Study Group. Intensive Care Med. 26(7):857-69, 2000
                                    7. Goodman LR et al: Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology. 213(2):545-52, 1999
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Acute respiratory distress syndrome (ARDS)

                                                • Synonyms

                                                  • Adult respiratory distress syndrome

                                                • Definitions

                                                  • Syndrome of acute respiratory failure caused by non-cardiogenic pulmonary edema.
                                                  • Berlin criteria
                                                    • Onset within 1 week of clinical insult or new/worsening respiratory symptoms
                                                    • Chest radiography: Bilateral opacities (not explained by pleural effusion, lobar/lung collapse, or nodules)
                                                    • PF ratio < 300 mm Hg with minimum of 5-cm H20 positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP)
                                                      • PaO₂:FiO₂ = PF ratio: Ratio of arterial oxygen tension to fraction of inspired oxygen
                                                    • Respiratory failure not fully explained by cardiac failure/fluid overload

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      Selected References

                                                                      1. Tsuchiya N et al: Imaging findings of pulmonary edema: part 1. Cardiogenic pulmonary edema and acute respiratory distress syndrome. Acta Radiol. 61(2):184-94, 2020
                                                                      2. Huppert LA et al: Pathogenesis of acute respiratory distress syndrome. Semin Respir Crit Care Med. 40(1):31-9, 2019
                                                                      3. Reilly JP et al: Acute respiratory distress syndrome phenotypes. Semin Respir Crit Care Med. 40(1):19-30, 2019
                                                                      4. ARDS Definition Task Force et al: Acute respiratory distress syndrome: the Berlin Definition. JAMA. 307(23):2526-33, 2012
                                                                      5. Desai SR et al: Acute respiratory distress syndrome caused by pulmonary and extrapulmonary injury: a comparative CT study. Radiology. 218(3):689-93, 2001
                                                                      6. Puybasset L et al: Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT Scan ARDS Study Group. Intensive Care Med. 26(7):857-69, 2000
                                                                      7. Goodman LR et al: Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology. 213(2):545-52, 1999