Acute Respiratory Distress Syndrome: Imaging of the Injured Lung

doi:10.1053/crad.2001.0889

Clinical Radiology

Volume 57, Issue 1, January 2002, Pages 8-17

https://doi.org/10.1053/crad.2001.0889 Get rights and content

Abstract

In patients with the acute respiratory distress syndrome (ARDS), there is non-specific but widespread exudation of oedema and inflammatory fluid into the lungs. The clinical corollary (dyspnoea, refractory hypoxia, reduced pulmonary compliance and diffuse pulmonary infiltrates) is catastrophic and generally associated with a poor outcome. Imaging is integral to the care of these critically ill patients on the intensive care unit. In the present review, the radiological changes on plain radiography and computed tomography (CT) in patients with ARDS are discussed. Particular attention is directed at the appearances on CT: the relationships between CT features, histopathological changes and the inevitable alterations in pulmonary physiology are explored. Desai, S. R. (2002)Clinical Radiology57, 8–17.

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Citation Excerpt :
ARDS is characterized by diffuse alveolar damage, often resulting in widespread edema and fluid buildup in the lungs. The clinical corollary is catastrophic and generally associated with poor outcomes, with such risks increasing with age and severity of illness [3]. Furthermore, early studies have shown that ARDS is associated with the novel coronavirus disease 2019 (COVID-19) – specifically in severe cases where it is hypothesized that the virus travels beyond the upper airway, moving through the lungs and causing a widespread inflammation in the alveoli [4].
Acute respiratory distress syndrome (ARDS) is a life-threatening lung injury with global prevalence and high mortality. Chest x-rays (CXR) are critical in the early diagnosis and treatment of ARDS. However, imaging findings may not result in proper identification of ARDS due to a number of reasons, including nonspecific appearance of radiological features, ambiguity in a patient's case due to the pathological stage of the disease, and poor inter-rater reliability from interpretations of CXRs by multiple clinical experts. This study demonstrates the potential capability of methodologies in artificial intelligence, machine learning, and image processing to overcome these challenges and quantitatively assess CXRs for presence of ARDS. We propose and describe Directionality Measure, a novel feature engineering technique used to capture the “cloud-like” appearance of diffuse alveolar damage as a mathematical concept. This study also examines the effectiveness of using an off-the-shelf, pretrained deep learning model as a feature extractor in addition to standard features extracted from the histogram and gray-level co-occurrence matrix (GLCM). Data was collected from hospitalized patients at Michigan Medicine's intensive care unit and the cohort's inclusion criteria was specifically designed to be representative of patients at risk of developing ARDS. Multiple machine learning models were used to evaluate these features with 5-fold cross-validation and the final performance was reported on a hold-out, temporally distinct test set. With AdaBoost, Directionality Measure achieved an accuracy of 78% and AUC of 74% – outperforming classification results using features from the histogram (75% accuracy and 73% AUC), GLCM (76% accuracy and 73% AUC), and ResNet-50 (77% accuracy and 73% AUC). Further experimental results demonstrated that using all feature sets in combination achieved the best overall performance, yielding an accuracy of 83% and AUC of 79% with AdaBoost. These results demonstrate the potential capability of using the proposed methodologies to complement current clinical analysis for detection of ARDS from CXRs.
Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study
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Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined.
Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP?
This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes.
We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups.
SP as a form of COVID-19 presentation at the ED is unusual (< 1‰ cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.
Imaging Early Postoperative Complications of Cardiothoracic Surgery
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Citation Excerpt :
Patients presenting with clinical manifestations of ARDS often have radiographic findings, such as dependent atelectasis and patchy areas of lung consolidation, similar to those of infection and hemorrhage. The opacities become denser and more confluent over a period of just days with air bronchograms becoming apparent.15 CT findings include diffuse or patchy ground-glass opacities, which can have a geographic distribution with normal lobules located adjacent to abnormal lobules, and the subpleural regions of the lungs can be spared (Fig. 2).
Investigating the potential to assess severe lung inhalation injuries using computed tomography
2019, Burns
Citation Excerpt :
Typical lung CT images of ARDS patients demonstrated not only ground-glass opacification, but also lung consolidation, which was more obvious in the lower lobe of the lung. Their distributions depended on the severity of the ARDS, where the area of lung consolidation and the extent of ground-glass opacification both increased with severity [20,21]. All of the above studies evaluated the potential use of CT in assessing the degree of inhalation injury.
The purpose of this study is to investigate the potential use of computed tomography (CT) in assessing inhalation injuries at various levels by studying the changes in lung imaging of rabbits with severe inhalation injury.
The sham, serious, critical, and extremely critical lung inhalation injury models were established by the New Zealand white rabbits’ inhalation of steam for 0 s, 0.25 s, 0.50 s, and 1.00 s, respectively. Lung CT scans were performed at 1, 4, and 12 h after the administration of steam and a radiologist’s scores (RADS) were collected for each CT scan. Lung tissues were later collected to measure the lung wet/dry weight (W/D) ratio and to determine pathological scores. The correlation of the RADS with the lung-tissue pathological scores and W/D changes was investigated.
The RADS and lung-tissue pathological scores are dependent on the time after injury and the level of injury. W/D ratios are dependent on the level of injury. The W/D ratio showed an increasing trend from 1 h to 4 h for the 0.25 s, 0.50 s, and 1 s inhalation injury groups, while the W/D ratio decreased from 4 h to 12 h for the 0.25 s and 0.50 s inhalation injury groups. Further analysis indicates that, at the same time point, the lung RADS positively correlates with both the lung pathological scores and W/D ratios.
A lung CT scan is able to reflect the early-stage lung injuries of rabbits with different levels of severe inhalation injury.
The role of imaging in the diagnosis of bronchiectasis: the key is in the distribution
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Diseases that involve the medium caliber airways (segmental and subsegmental bronchi) are common and present clinically with nonspecific respiratory symptoms such as cough, recurrent respiratory infections and occasionally, hemoptysis. The abnormal and irreversible dilation of bronchi is known as “bronchiectasis”. The diagnosis can be challenging and the analysis of the regional distribution of the bronchiectasis is the most useful diagnostic guide. The objective of this manuscript is to describe the main imaging findings of bronchiectasis and their classification, review the diseases that most commonly present with this abnormality, and provide an approach to the diagnosis based on their imaging appearance and anatomic distribution. Bronchiectasis is a frequent finding that may result from a broad range of disorders. Imaging plays a paramount role in diagnosis, both in the detection and classification, and in the diagnosis of the underlying pathology.
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View all citing articles on Scopus

^f1: Author for correspondence and guarantor of study: Dr Sujal R. Desai, Department of Radiology, King's College Hospital, Denmark Hill London SE5 8EQ, U.K. Fax: +44(0)20 7346 3157; E-mail: [email protected]

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ReviewAcute Respiratory Distress Syndrome: Imaging of the Injured Lung

Abstract

Lancet

Chest

Chest

Chest

Chest

Chest

Clin Chest Med

Clin Chest Med

Chest

Chest

Clin Radiol

Chest

Chest

Chest

The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination

Am J Respir Crit Care Med

Current definitions of acute lung injury and the acute respiratory distress syndrome

Intensive Care Med

ARDS and the search for meaningful subgroups

Intensive Care Med

Survival in patients with severe adult respiratory distress syndrome treated with high-level positive end-expiratory pressure

Crit Care Med

Diffuse alveolar damage – the role of oxygen, shock, and related factors: a review

Am J Pathol

Adult respiratory distress syndrome: acute alveolar damage

Radiology

Adult respiratory distress syndrome

Diffuse alveolar damage, the pathological basis of the adult respiratory distress syndrome

Pathologic features and mechanisms of hypoxaemia in adult respiratory distress syndrome

Am Rev Respir Dis

Pulmonary fibrosis in severe acute respiratory failure

Am Rev Respir Dis

Type I collagen content is increased in lungs of patients with adult respiratory distress syndrome

Thorax

Adult respiratory distress syndrome: evidence of early fibrogenesis and absence of glucocorticoid receptors

Eur J Respir Dis

Fibroproliferation and mast cells in the acute respiratory distress syndrome

Thorax

Acute diffuse interstitial fibrosis of the lungs

Bull Johns Hopkins Hosp

Acute interstitial pneumonia: a clinicopathologic, ultrastructural, and cell kinetic study

Am J Surg Pathol

Acute interstitial pneumonia

Eur Respir J

Acute diffuse interstitial fibrosis of the lungs

Arch Intern Med

Acute diffuse interstitial fibrosis of the lungs: report of a case

Arch Intern Med

Diffuse interstitial fibrosis of the lungs

Am Rev Tuberculosis

Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification

Am J Respir Crit Care Med

The pathology and terminology of fibrosing alveolitis and the interstitial pneumonias

Imaging

Thoracic CT in detecting occult disease in critically ill patients

AJR Am J Roentgenol

Bedside chest radiography: diagnostic efficacy

Radiology

Value of routine daily chest x-rays in the medical intensive care unit

Crit Care Med

Pulmonary barotrauma during mechanical ventilation

Crit Care Med

Complications of acute respiratory failure

Am Rev Respir Dis

Pulmonary support and monitoring apparatus

Imaging the injured lung

The radiologic distinction of cardiogenic and noncardiogenic edema

AJR Am J Roentgenol

Basic patterns in lung disease

Review
Acute Respiratory Distress Syndrome: Imaging of the Injured Lung