Pulmonary transfusion reactions Quiz: Ace Your Exams

A 29-year-old man is evaluated in the emergency department following a high-speed motor vehicle collision. He sustained multiple fractures and suffered significant blood loss. Temperature is 38.7°C (101.7°F), heart rate is 110/min, blood pressure is 85/50 mmHg, respiratory rate is 24/min, and oxygen saturation is 90% on room air. He receives 2 units of O-negative packed red blood cells. Two hours after the transfusion, he develops dyspnea, hypoxemia, and a non-productive cough. On examination, he appears anxious, tachypneic, and is using accessory muscles of respiration. There are no rashes. The trachea is midline. There is no jugular vein distension. Pulmonary auscultation reveals bilateral rales. There is no lower extremity edema. The patient is intubated and mechanically ventilated. PaO₂/FiO₂ is equal to 230. Chest X-ray is shown below. Which of the following is the most likely diagnosis?
 
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