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Special Feature
April 2002

Image of the Month

Author Affiliations

From the Department of Surgery, University of Rochester Medical Center, Rochester, NY.


Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002

Arch Surg. 2002;137(4):491. doi:

A HEALTHY 42-YEAR-OLD farmer lost his balance while riding a tractor, which then ran over his chest and upper abdomen. A computed tomographic scan of the abdomen demonstrated a grade III liver laceration that was treated nonoperatively. However, during the next 12 hours, he developed progressive shortness of breath and required intubation. An arterial blood gas measurement gave the following results: pH, 7.31; PaO2, 57; and PCO2, 46, while the patient was receiving a fraction of inspired oxygen (FIO2) of 80%. Chest x-ray films obtained at admission (A) and after intubation (B) are shown in Figure 1.

What Is the Diagnosis?

A. Aspiration pneumonia

B. Cardiogenic pulmonary edema

C. Acute respiratory distress syndrome

D. Bilateral pneumonia

E. Acute lung injury