Case 95

 A ninety three-year-old female was transported to our hospital in the evening by ambulance which her daughter-in-law called necessity to help. The chief complaints were general fatigue and motion difficulty. At 2 pm., she washed dishes and cups in the kitchen. At 6 pm., she lied down and could not say anything except uttering voices. In these days, she had experienced some difficulty in breathing. Auscultation revealed coarse respiratory sound in the dorsal lower chest. PF ratio of blood gas 64.1: 55.8 mmHg [oxygen partial pressure (PO2 mmHg)] / 0.87 [fraction of inspiratory oxygen (Fi, decimal point)]. Laboratory test revealed red blood cells 603x106/mm³, white blood cells 6030/mm³, neutrophils 85.3 %, CRP 4.28 mg/dL, LDH 418 U/L, Procalcitonin 0.5-2 mg/dL (< 0.5), D dimer 2.2 μg/mL (< 1), KL6 602 U/L (< 500), MPOANKA < 1, PR3ANKA < 1 Chest CT was taken for further investigation (Fig. 1)

Based on clinical symptoms, laboratory test and chest CT, what caused acute respiratory distress syndrome (ARDS)?

1. Sepsis

2. Pulmonary embolism

3. Inhalation pneumonia

4. Microscopic polyangiitis

5. Acute interstitial pneumonia

answer

2018.3.7