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Diaphragmatic hypertrophy
3%
8/272
Proliferation of bronchiolar mucous glands
8%
21/272
Interstitial edema
53%
144/272
Large pulmonary embolus
33%
89/272
Left apical bronchoalveolar carcinoma
2%
5/272
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The patient's history of recent trauma puts him at high risk for acute respiratory distress syndrome which results in interstitial edema. Acute respiratory distress syndrome (ARDS) is a bilateral patchy airspace disease of acute onset and results in noncardiogenic pulmonary edema and severe hypoxemia. ARDS may follow severe trauma but can also be present after pneumonia, aspiration, near-drowning, sepsis, shock, pancreatitis, diffuse intravascular coagulation and transfusion of blood products. In ARDS, alveolar and interstitial edema reduce pulmonary compliance and increase intrapulmonary shunt (extreme V/Q mismatch), which leads to a decrease in ventilation and oxygenation. Saguil et al. detail the diagnosis and management of acute respiratory distress syndrome. Treatment is mainly supportive and includes mechanical ventilation, prophylaxis for stress ulcers and venous thromboembolism, nutritional support, and treatment of the underlying injury. Recent advances in ventilator management have succeeded in reducing mortality with low tidal volume, high positive end-expiratory pressure, and conservative fluid management. Matthay et al. describe ARDS pathogenesis and treatment. Lung injury is caused primarily by neutrophil and platelet-dependent damage to the endothelial and epithelial barriers of the lung. They note that there is no effective pharmacologic therapy but that mortality has been markedly reduced with a lung-protective ventilatory strategy. Figure A is a histological image of lungs with diffuse alveolar damage, which is the pathological term used to describe ARDS. Illustration A is the same image with an arrow pointing out the hyaline membranes within the alveolar spaces. Incorrect answers: Answer 1: Although lung compliance decreases in ARDS, mechanical ventilation can actually lead to diaphragmatic weakness and atrophy with longer durations of mechanical ventilation Answer 2: Proliferation of bronchiolar mucous glands is a finding in chronic bronchitis (COPD) and would not be present in ARDS. Answer 4: PE would not result in diffuse alveolar damage. Answer 5: Histopathology is not consistent with lung cancer.
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