PMC3334782_01
Chest CT performed on Day 3 and Day 37 after the onset of refractory hypoxaemia. a) Chest computed tomography (CT) on Day 3 following the onset of refractory hypoxaemia showing a bilateral consolidation of lower lobes with a right pleural effusion extending to the main fissura (upper CT section, parenchymal window). Large vessels are opacified within each lower lobe consolidation (middle CT section, mediastinal window). The application of a colour encoding system (lower part of the figure) confirms the consolidation of lower lobes [red colour, characterizing nonaerated lung regions with CT attenuations > -100 Hounsfield densities (HU)], shows the hypervascularization of lung consolidations (black colour, characterizing pulmonary vessels containing contrast material with CT attenuations > +200 HU) and evidences the hyperinflation of upper lobes (white colour, characterizing hyperinflated lung regions with CT attenuations < -900 HU). Normally (dark grey colour, characterizing lung regions with CT attenuations ranging between -900 and -500 HU) and poorly aerated lung regions (light grey colour, characterizing lung regions with CT attenuations ranging between -500 and -100 HU) are located to upper lobes. b) The same CT sections obtained at Day 20 following liver transplantation (37 days after the onset of refractory hypoxaemia) showing a persisting consolidation of the right lower lobe without pleural effusion. Large vessels are not anymore opacified within the consolidation (middle CT section, mediastinal window). The application of the colour encoding system (lower part of the figure) confirms the consolidation, the presence of hyperinflated lung regions in upper lobes. It does not show anymore hypervascularization within the right consolidation, suggesting a regression of HPS.
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F1
Contrasting with bedside anterior chest radiography, contrast computed tomography (CT) of the thorax demonstrated bilateral consolidations of lower lobes with dilated pulmonary vessels, moderate right pleural effusion and no evidence of pulmonary embolism (Figure 1a). Secondary analysis of CT sections with the colour encoding system of the software Lungview  (Institut National des Telecommunications, Evry, France), confirmed the presence of enlarged pulmonary vessels within consolidations, suspected on mediastinal windows (Figure 1a). As shown in Figure 1b, the left lower lobe was completely re-aerated whereas the right lower lobe appeared atelectatic, free of enlarged pulmonary vessels.