A 50-year-old male with severe acute pancreatitis develops tachypnea, severe hypoxemia (), and bilateral diffuse alveolar infiltrates on chest radiograph without evidence of left atrial hypertension. What pulmonary complication has occurred?

Answer and explanation

Correct answer: D. Acute respiratory distress syndrome (ARDS)

  1. Step 1: Under the Berlin definition, Acute Respiratory Distress Syndrome (ARDS) is defined by acute onset of bilateral non-cardiogenic pulmonary infiltrates within 1 week of a clinical insult, with a ratio <= 300 mmHg on PEEP >= 5 cm .
  2. Step 2: A between 100 and 200 indicates moderate ARDS.
  3. Step 3: Severe pancreatitis triggers systemic inflammatory release of cytokines causing diffuse alveolar endothelial and epithelial damage.
Answer
Acute respiratory distress syndrome (ARDS).
Why not the others: 'Pulmonary embolism' typically produces wedge-shaped peripheral infarcts without diffuse bilateral infiltrates; 'Aspiration pneumonia' produces focal consolidations, typically in dependent bronchopulmonary segments; 'Cardiogenic pulmonary edema' requires elevated left atrial filling pressures (wedge pressure > 18 mmHg).

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