Does ARDS cause severe lung opacities?

Question

Hi doctor,

My dad has had recurring lung issues for the past 14 years. Several times, his chest X-rays have shown his lungs so clouded they appeared completely opaque in all five lobes. In the two worst cases, he was diagnosed with acute respiratory distress syndrome (ARDS) and placed on a ventilator for 14 and 10 days. Initially, pneumonia was suspected, but this diagnosis was revised after no fluid was found in the lungs, even with a bronchoscopy.

He has type II diabetes, which made the ARDS very dangerous. Despite this, he was treated successfully with steroids, even though it carried risks for a diabetic. The Intensive care unit (ICU) focused on saving his life, but the root cause of his lung issues remains unknown. This is concerning because it has happened at least three times, and his chest X-rays are still far from normal even four weeks after his ICU discharge.

Since moving to a post-acute care facility, his oxygen saturation levels have dropped to around 86 twice. My mom has been checking it regularly at home for 14 years. His care has always been reactive, never proactive. There seems to be a pattern, as this happens about every 18 months.

What could cause such severe lung opacities without fluid or a known infection?
If it is an infection, what kind could affect all five lobes?

Please help.

Thank you.

Answer 1

Hi,

Welcome to Icliniq.com.

I can understand your concerns about your father's health and assure you to help as much as possible.

I have read your query and details about his past illnesses thoroughly. Acute respiratory distress syndrome (ARDS) is a very difficult situation to treat, and you can suffer from many health issues affecting your lungs in spite of the best treatment. As you said, he had an episode of ARDS treated with full doses of steroids and many more complications after that.

Now, according to me, he may be suffering from any interstitial lung disease, most probably idiopathic pulmonary fibrosis or lung Fibrosis, resulting in a drop in his oxygen saturation. But we need to do High-resolution computed tomography (HRCT) thorax to confirm the diagnosis. Even if it is not IPF, a computed tomography scan will help us find other causes of lung fibrosis. About the treatment of IPF, again, it is very long and mainly depends on steroids and immunosuppressive drugs. But let me clear you that all the treatment options can be clarified only after an HRCT scan.

I hope you are now clear with the idea about the possible recurrence of your father's illness.

Let me know if I can assist you further.

Thank you