Fig. 4.37 Diffuse airspace opacities (consolidative pattern) caused by blast injury

Case 4.12

The young soldier in Fig. 4.37 was exposed to a blast.

Findings: Bilateral and diffuse fluffy/patchy opacities. Also, ET well above carina, right and left central line tips in SVC, enteric tube in stomach.

Pattern: Consolidation, diffuse, patchy.

Differential Diagnosis: Secondary to (or concomitant with) ARDS.

Diagnosis: ARDS. Note: There remains some debate as to mechanisms of blast lung injury; however, from a clinical standpoint, this patient (as many post-blast patients) was diagnosed with ARDS before evacuation out of the combat zone.

Protein (Secretions)

Mucous protein can plug alveoli from a number of injuries and diseases, including Pulmonary Alveolar Proteinosis (PAP), shown in the case below. Keep in mind that this is a findings-based approach, and this same diagnostic category can be found through the interstitial pathway (similar to edema).

Case 4.13 (see Figs. 4.38 and 4.39)

Findings: Bilateral diffuse fluffy/ patchy airspace opacities. Pattern: Consolidation (could also be categorized as interstitial).

Differential Diagnosis: ARDS, PAP, aspiration, and less likely interstitial considerations.

Diagnosis: PAP. CT shows crazy paving (see Fig. 4.39).