This patient initially presented with Status Asthmaticus. Despite aggressive medical management, her condition failed to improve and she was intubated for mechanical ventilation. While on the ventilator, the patient developed significant auto-PEEP (PEEP – positive end expiratory pressure or pressure remaining in the lungs after an exhalation) as a result of air trapping. This lead to barotrauma with a left sided pneumothorax and an extensive SQ emphysema (white arrow on the image above).

24 year old female with a history of asthma and tobacco abuse presented with a progressively worsening shortness of breath and coughing. Her exam revealed extensive wheezing. She was admitted for further treatment of her asthma.

On the chest XR above, note hyperinflated lungs with depressed diaphragms on both sides. The hallmark of asthma is airway narrowing due to inflammation and airway muscle constriction. The patients are unable to fully exhale due to the narrowed airway. This causes air trapping leading to hyperinflation of both lungs.

56 year old female with a history of morbid obesity and obstructive sleep apnea, presented with a progressively worsening shortness of breath. Arterial blood gas showed evidence of hypoventilation and CO2 retention. Eventually, the patient had to be intubated for respiratory failure. Echocardiography revealed evidence of right ventricular failure and pulmonary hypertension due to chronic hypoventilation and hypoxemia. The Chest XR above demonstrates low lung volumes and a significant amount of subcutaneous tissue.