PDF(Pubmed)
Abstract：
Acute respiratory distress syndrome (ARDS) presents a formidable challenge in critical care, often resulting in high mortality rates, particularly in severe cases or those compounded by preexisting conditions. Despite substantial advancements in critical care, the heterogeneous nature of ARDS necessitates nuanced clinical approaches. ARDS is generally diagnosed through clinical evaluation, radiographic imaging, and laboratory tests, as well as acute onset, bilateral lung infiltrates on imaging, and a partial pressure of oxygen in arterial blood (PaO2)/fraction of inspiratory oxygen concentration (FiO2) ratio of less than 300 mmHg. Management involves measurements to improve oxygenation and provide mechanical ventilation to assist breathing. The typical manifestation of ARDS is diffuse lung involvement, which affects multiple lobes symmetrically. Here, we report an unusual case of ARDS in a 53-year-old female who was brought into the hospital in an unresponsive state, exhibiting hypoxic and hypotension requiring intubation. Subsequent imaging revealed a distinctive pattern: the preservation of the right middle lobe, diverging from the conventional diffuse pulmonary affliction. This case underscores the need for clinical vigilance and adaptability, as such atypical presentations can confound diagnosis and management, posing unique clinical challenges. This case highlights the importance of recognizing ARDS\' diverse presentations. Moreover, understanding the mechanisms behind the lobar sparing could provide greater insight into the disease heterogeneity and guide tailored therapeutic approaches. The imperative for further research into these uncommon presentations is clear, as it may be vital to improving outcomes for a broader spectrum of ARDS patients.
摘要：
急性呼吸窘迫综合征（ARDS）在重症监护中提出了巨大的挑战，往往导致高死亡率，特别是在严重的情况下或那些因先前存在的疾病而加剧的情况下。尽管重症监护取得了实质性进展，ARDS的异质性需要细微差别的临床方法。ARDS通常通过临床评估来诊断，射线成像，和实验室测试，以及急性发作，影像学检查双侧肺浸润，并且动脉血中的氧分压(PaO2)/吸气氧浓度分数(FiO2)比率小于300mmHg。管理涉及改善氧合和提供机械通气以辅助呼吸的测量。ARDS的典型表现为弥漫性肺受累,对称地影响多个瓣。这里,我们报告了一个不寻常的ARDS病例，一名53岁的女性在无反应状态下被带入医院，表现出缺氧和低血压，需要插管。随后的成像显示了一个独特的模式：保留了右中叶，与传统的弥漫性肺部疾病不同。这一案例强调了临床警惕性和适应性的必要性,因为这种非典型的表现会混淆诊断和管理，带来独特的临床挑战。这个案例强调了识别ARDS的不同表现的重要性。此外，了解肺叶保留背后的机制可以更深入地了解疾病异质性,并指导量身定制的治疗方法.对这些不常见的演示文稿进行进一步研究的必要性很明显，因为这对于改善更广泛的ARDS患者的结局可能至关重要。
