Presentation
Referred to the Emergency service for mechanical ventilation. Vomiting after ingesting a bone, which progressed to acute respiratory distress.
Patient Data
Diffuse patchy alveolar infiltrates are seen throughout both hemithoraces. The pattern is present in all lung lobes with many indistinct air bronchograms. The pulmonary vasculature is poorly visualized; however, the cardiovascular structures appear to be within normal limits. An endotracheal tube is present within the trachea to the level of the carina. An esophageal feeding tube is also seen extending to the level 3rd ribs before folding back on itself on the initial lateral projections. A final left lateral projection reveals the esophageal tube passing through the length of the esophagus and into the gastric fundus.
Case Discussion
The primarily alveolar infiltrates are consistent with non-cardiogenic edema (e.g. acute respiratory distress syndrome or ARDS).
At necropsy, the lung changes were consistent with ARDS and interstitial pneumonia. The initial aspiration event caused by the vomiting developed into a more severe inflammatory response resulting in pulmonary edema.
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