Respiratory distress syndrome Quiz: Ace Your Exams

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A 67-year-old man with a history of hypertension, hyperlipidemia, and hepatitis C cirrhosis is transferred to the intensive care unit due to hypoxemic respiratory failure. The patient was initially admitted for management of a right middle lobe pneumonia, but today the patient was noted to have altered mental status and tachypnea. His temperature is 38°C (100.4°F), pulse is 108/min, respirations are 26/min, blood pressure is 100/94 mmHg, and oxygen saturation is 85% on room air. Physical examination shows a man in moderate respiratory distress with evidence of accessory muscle use. Auscultation reveals bilateral rales throughout the lung fields. The patient is subsequently intubated and sedated for airway protection. Follow up chest x-ray, laboratory results, and cardiovascular studies are demonstrated below:

A chest X-ray shows diffuse, bilateral infiltrates in the lungs. Tubes are visible in the upper chest, suggesting critical care. The image is in grayscale.

_{Reproduced from: Wikipedia}

Which of the following best describes the most likely pathophysiology of this acute disease process?

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Leakage of protein-poor fluid into the alveolar space due to increased hydrostatic pressure

Focal necrosis with an area of surrounding pulmonary hemorrhage

Increased bronchoalveolar fluid containing eosinophils

Leakage of protein-rich fluid into the alveolar space due to damage of alveolar capillaries

Pulmonary hemorrhage with formation of hemosiderin laden macrophages