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5. 1 + 2
Asbestos fiber inhalation can lead to diverse pulmonary disorders including asbestosis, pleural disease and malignancy. Asbestosis represents diffuse pulmonary fibrosis, and peripheral reticular opacities with lower lung field predilection are the characteristic chest x-ray findings. CT scan helps diagnosis of early stage asbestosis with normal chest x-ray finding, and subpleural curvilinear lines, pleural thickening, lobular septal thickening, and honeycombing change are commonly found on CT image (1).
Later on the same day, patient developed severe hypoxemia requiring intubation and ICU transfer. The arterial blood gases (ABG) before intubation were as follows:
ABG: pH 7.37, pCO2 36.0 mmHg, pO2 68.0 mmHg HCO3- 20.8 meq/L, SaO2 90.8 % while receiving 10 L O2 NRB
Broad spectrum coverage for bacterial and fungal disease was begun with vancomycin, azithromycin, meropenem and fluconazole. However, testing for mycoplasma, coccidioidomycosis, legionella, respiratory viral panel, sputum, and blood cultures were all negative. Subsequent bronchoalveolar lavage showed a cell count of 0.46 X 106 and a differential of 83% neutrophils, 3% lymphocytes, 13% macrophages, and 1% eosinophils with no evidence of infection.
A chest x-ray and chest CT were performed after intubation (Figure 2).
Figure 2. Portable AP of chest (Panel A) and representative lung window from thoracic CT scan (Panel B) performed after intubation.
What is the most common cause of respiratory decompensation in interstitial lung disease (ILD) patients? (click on correct answer to move to next panel)