Radiological Imaging in Acute Lung Injury and Acute Respiratory Distress Syndrome

Pietro Caironi; Eleonora Carlesso; Luciano Gattinoni

doi:10.1055/s-2006-948294

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2006; 27(4): 404-415
DOI: 10.1055/s-2006-948294

Radiological Imaging in Acute Lung Injury and Acute Respiratory Distress Syndrome

Pietro Caironi¹ , Eleonora Carlesso¹ , Luciano Gattinoni¹

¹Istituto di Anestesiologia e Rianimazione, Dipartimento di Anestesia, Rianimazione, e Terapia del Dolore, Fondazione IRCCS-“Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena” di Milano, Università degli Studi di Milano, Milano, Italy

Abstract

ABSTRACT

Computed tomography (CT) has been utilized to study acute respiratory distress syndrome (ARDS) since the middle 1980s, when it revealed the inhomogeneous pattern of the lung lesion. Its advantages rely on the strict correlation between CT density and the lung physical density, allowing a quantification of lung compartments with different degrees of aeration. By CT scans, ARDS lung appeared to be “small” rather than “stiff,” leading to the “baby lung” concept. The regional analysis revealed that this appearance derives from an evenly distributed lung edema, which tends, because of gravitational forces, to lie predominantly in the most dependent regions, leading to alveolar collapse. New data suggest that such a “sponge lung” is made by a “core,” consolidated, lung portion, from which, through an inflammatory reaction, lung edema will spread, determining the collapsed and recruitable lung portion. The amount of recruitable lung varies among ARDS patients. This knowledge is necessary for a rational positive end-expiratory pressure (PEEP) setting because the amount of tissue maintained aerated by PEEP is closely associated with the amount of recruitable lung. CT scans may also help to diagnose ARDS because CT provides a good estimate of the high-permeability lung edema, the characteristic lesion of this syndrome.

KEYWORDS

Acute respiratory distress syndrome - computed tomography - lung recruitment - positive end-expiratory pressure - mechanical ventilation

Full Text

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Luciano GattinoniM.D.

Istituto di Anestesiologia e Rianimazione, Fondazione IRCCS-“Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena” di Milano, Università

degli Studi di Milano, Via F. Sforza 35, 20122 Milano, Italy

Email: gattinon@policlinico.mi.it