Dynamic chest radiography for wheezing-associated acute respiratory failure: 4 case reports

Dynamic chest radiography is a bedside, low-dose X-ray technique that captures sequential images to visualize respiratory and cardiovascular motion and to derive ventilation maps. We present a case series of 4 patients with wheezing-associated acute respiratory failure from diverse etiologies (presumed asthma exacerbation, tracheobronchomalacia, cardiogenic pulmonary edema, and endotracheal mucus plugging). In each case, dynamic chest radiography provided real-time functional information that complemented initial evaluations when conventional tests were inconclusive. It suggested diffuse airflow limitation in the presumed asthma case, demonstrated expiratory central airway collapse in tracheobronchomalacia, supported pulmonary congestion without ventilation loss in heart failure, and revealed unilateral ventilation impairment due to mucus plugging in an intubated patient. These findings informed bedside clinical decision-making. Dynamic chest radiography may serve as a practical adjunct that increases diagnostic confidence in emergency and critical care settings where rapid, noninvasive functional assessment is desirable.