Review Question - QID 100927

The clinical presentation is consistent with acute respiratory distress syndrome (ARDS). Given this patient's risk factors and physical exam the most likely cause is pancreatitis.

ARDS is the result of severe, acute lung injury. ARDS is characterized by the acute onset of diffuse, bilateral pulmonary infiltrates which cannot be attributed to cardiogenic pulmonary edema. Additionally, ARDS presents with refractory hypoxia and decreased lung compliance. ARDS occurs most frequently in the setting of sepsis, aspiration of gastric contents, pancreatitis, or trauma.

Figure A shows the typical chest radiograph findings of ARDS, with bilateral opacification of the entire lung field. Of note, a pulmonary embolism typically has a normal chest radiograph.

Incorrect Answers:
Answer 2: Gastric aspiration is certainly a concern in intoxicated patients as a cause of ARDS; however, there are no upper lobe infiltrates on chest radiograph suggestive of this.

Answer 3: Pulmonary embolism is not a typical cause of ARDS and is a less likely causative factor in the setting of this patient's abdominal tenderness and intoxicated presentation.

Answer 4: Septic shock could explain ARDS; however, the patient's epigastric tenderness and likely intoxication with alcohol makes pancreatitis a more likely diagnosis.

Answer 5: Trauma can be a precipitating cause of ARDS; however, this patient's physical exam does not reveal any traumatic findings.

Bullet Summary:
Pancreatitis, septic shock, trauma, and gastric aspiration are all potential causes of acute respiratory distress syndrome (ARDS).