Smoke inhalation: radiologic manifestations

The medical records and radiographs of 62 patients admitted for smoke inhalation were reviewed to determine the value of the plain chest radiograph in the early detection of inhalation injury. Pulmonary edema resulting from the inhalation injury often leads to pulmonary insufficiency, and its early diagnosis is crucial to the management of patients with this condition. In addition to the usual presentation of pulmonary edema, subtle radiographic findings of interstitial edema such as perivascular fuzziness and peribronchial "cuffing" were observed. Of 56 patients with significant inhalation injury, 35 (62.5%) had radiographic findings attributed only to smoke inhalation. These abnormalities often had a characteristic distribution in the lungs, and in the majority of patients they appeared in the first 24 hours after the injury. The radiologic diagnosis of inhalation injury may be made at a time when findings of other diagnostic tests are still equivocal or mildly abnormal, thus alerting the clinician to impending pulmonary failure.