The consultant suspects a pulmonary-renal syndrome because of bilateral alveolar infiltrates
(diffuse alveolar hemorrhage).
The lesions of chronic hydrocarbon aspiration are quite different, presenting with pseudotumours' or crazy paving alveolar infiltrates
having negative CT attenuation values (Hounsfield Units <0)(25).
Her chest x-ray showed diffuse interstitial and alveolar infiltrates
in a bat wing pattern.
An X-ray showed bilateral alveolar infiltrates
, and blood gas analysis revealed the following: pH: 7.390; partial pressure of arterial carbon dioxide (PaC[O.sub.2]): 28.3 mmHg; and partial pressure of arterial oxygen (Pa[O.sub.2]): 70.4 mmHg HC[O.sub.3.sup.-] 16.8mmol/L with fraction of inspired oxygen ([F.sub.1][O.sub.2]) of 1.0 as well as positive end-expiratory pressure (PEEP) of 10 cm [H.sub.2]O.
Table 2: Schonfeld's Criteria (9) * Petechiae Score 5 * Chest X ray changes (Diffuse alveolar infiltrates
) Score 4 * Hypoxemia (PaO2< 70 mm Hg) Score 3 * Fever (> 38C) Score 1 * Tachycardia (> 120 bpm) Score 1 * Tachypnoea(>30 / min) Score 1
A chest x-ray showed new, multifocal, and extensive alveolar infiltrates
throughout the right hemithorax.
Axial computed tomography (CT) scans of the chest demonstrated ground glass haziness with diffuse bilateral alveolar infiltrates
with a cavitary mass-like consolidation in the left lung base (Figure-2).
Two formats were used for this readings: I) conventional, in which the presence, localization and type of infiltrates were evaluated, discriminating between alveolar infiltrates
(with or without air bronchogram), and interstitial infiltrates (of nodular, reticular or mixed types); unilobar or multilobar infiltrates, and pleural effusion; and II) quantitative scale, which assigns a score according to the extension of the pulmonary injury, determined by the number of affected intercostal spaces.
Focal infiltrates, nodules and diffuse alveolar infiltrates
are less common findings and were noted in 2 of our patients.
was the most common feature, accounting for 9 (41%) of 22 anomalies observed in the lung by chest radiograph, followed by interstitial pattern (27%) and pleural suffusion (18%).
The chest X-ray showed massive alveolar infiltrates
The CT scan confirmed diffuse patchy alveolar infiltrates
and small bilateral pleural effusions (Figure 2).