Question

A patient is a known case of acute pancreatitis develops breathlessness, bilateral basal crepitation on day 4 and chest radiography as shown in the image below. What will be the diagnosis?

• A. Bilateral pneumonia
• B. ARDS
• C. Carcinogenic PE
• D. Collapse

Answer 1

The Correct Option is B

In this clinical scenario, the patient with a known case of acute pancreatitis presents with breathlessness and bilateral basal crepitations on day four, along with a specific chest radiograph image. The differential diagnosis involves:

• Bilateral pneumonia
• ARDS (Acute Respiratory Distress Syndrome)
• Carcinogenic Pleural Effusion (PE)
• Lung Collapse

Given the symptoms and the timing (day four of acute pancreatitis), ARDS is the most likely diagnosis. Here's why:

Step-by-step Analysis

1. Acute Pancreatitis Background: Complications from acute pancreatitis can include respiratory distress due to systemic inflammatory responses.
2. Symptoms and Timelines: On day four, the development of breathlessness and bilateral basal crepitations is a classic feature seen in ARDS due to fluid accumulation in the lungs and impaired gas exchange.
3. Chest Radiography Interpretation: Though the image isn't presented here, ARDS typically shows bilateral pulmonary infiltrates consistent with pulmonary edema, without evidence of cardiac failure.
4. Excluding Other Options:
   • Bilateral pneumonia would likely present with fever, cough, and a more gradual onset.
   • Carcinogenic PE usually develops over a longer period and involves pleural effusion, evident in imaging.
   • Collapse of lung typically shows loss of lung volume with displacement of structures, not diffuse infiltrates.

Conclusion

The clinical data points strongly towards ARDS due to the acute onset post-pancreatitis, radiological findings, and exclusion of other possibilities.