CTICasesAcute Respiratory Distress Syndrome (ARDS) with Fibrosis Resolution
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Imaging findings
CT in the acute phase of sepsis-induced acute respiratory distress syndrome (ARDS) reveals a classic dependent gradient of lung injury, with symmetric ground-glass opacities in the anterior lungs transitioning to dense consolidative collapse and transient bronchial dilation in the posterior lower lobes. A follow-up CT after clinical recovery demonstrates remarkable resolution of the consolidations and bronchial dilation, leaving behind only minimal, subtle residual architectural distortion and fibrosis.
Key takeaways
The severe bronchial dilation often seen during the acute, consolidative phase of diffuse alveolar damage (DAD) represents transient traction bronchiectasis due to alveolar collapse, rather than permanent airway destruction, and can fully resolve. The development of permanent, fixed fibrosis after DAD depends on whether the alveolar basement membrane remains intact to allow orderly re-epithelialization or is disrupted, leading to disorganized fibroblastic proliferation.
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