The White Chest

A 39 -year-old man underwent distal gastrectomy and vagotomy for refractory peptic ulcer disease. The surgery and initial postoperative period were uneventful. Forty-eight hours after surgery, he developed progressive respiratory failure and ARDS, necessitating admission to the ICU and mechanical ventilation. Severe hypoxemia persisted despite the use of high ventilatory pressures and a fraction of inspired oxygen of 0.8 to 1.0. A supine anteroposterior chest radiograph was taken later that day (Fig 1).