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CT predictors of mortality in pathology confirmed ARDS

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Abstract

Objectives

To identify CT findings that predict mortality in acute respiratory distress syndrome (ARDS) and to identify CT findings that differentiate diffuse alveolar damage (DAD) from DAD with prominent histopathological features of organizing pneumonia (DAD-OP).

Methods

Twenty-eight patients with ARDS (corroborated by open biopsy) and chest CT within 2 weeks of biopsy were included in our study. Differences in CT findings in patients with survivors versus nonsurvivors as well as for DAD versus DAD-OP were compared using Fisher’s exact test.

Results

Lung involvement of greater than 80%, RA/LA ratio >1, and varicoid traction bronchiectasis were statistically more common in nonsurvivors than in survivors (respective p values of 0.001, 0.008, and 0.038). PA dilation greater than 3 cm and RV/LV ratio greater than 0.9 were also more common in nonsurvivors than in survivors but these factors did not achieve significance. CT findings did not differentiate DAD from DAD-OP.

Conclusion

Our study suggests that >80% of lung involvement, RA/LA ratio >1, and varicoid bronchiectasis predict mortality in patients with ARDS/DAD. Signs of right-sided heart failure (PA dilation greater than 3 cm and RV/LV ratio greater than 0.9) approached significance. CT findings did not differentiate DAD from DAD-OP.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

DAD:

Diffuse alveolar damage

OP:

Organizing pneumonia

CT:

Computed tomography

MDCT:

Multidetector computed tomography

PA:

Pulmonary artery

RA:

Right atrium

LA:

Left atrium

RV:

Right ventricle

LV:

Left ventricle

AP:

Anterior-posterior

PA:

Posterior-anterior

AIP:

Acute interstitial pneumonitis

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA, 02114, USA

    Jonathan H. Chung, Reginald E. Greene, Jo-Anne O. Shepard & Subba R. Digumarthy

  2. Department of Pathology and Pulmonary Medicine, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA, 02114, USA

    Richard L. Kradin

Authors
  1. Jonathan H. Chung
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  2. Richard L. Kradin
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  5. Subba R. Digumarthy
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Correspondence to Subba R. Digumarthy.

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Chung, J.H., Kradin, R.L., Greene, R.E. et al. CT predictors of mortality in pathology confirmed ARDS. Eur Radiol 21, 730–737 (2011). https://doi.org/10.1007/s00330-010-1979-0

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  • DOI: https://doi.org/10.1007/s00330-010-1979-0

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