Air bronchogram in a patient with ESRD: NEJM case report
A 26-year-old woman with end-stage renal disease secondary to lupus nephritis presented with a 3-day history of fever, cough, and shortness of breath, symptoms that are consistent with pneumonia. The acute respiratory distress syndrome (ARDS) developed, and the patient ultimately required extracorporeal membrane oxygenation (ECMO) after the failure of mechanical ventilation.

A dual lumen ECMO catheter was placed in the right internal jugular vein to drain blood from the superior and inferior vena cavae and return it to the right atrium. Portable anterior–posterior chest radiography showed dense airspace disease with bilateral hemithorax opacification and air bronchograms, a radiologic sign in which the air-filled bronchi are visible as a consequence of the opacification of the surrounding alveoli.

Shortly thereafter, cultures from bronchoalveolar lavage revealed Moraxella catarrhalis and Haemophilus influenzae. The patient was treated with appropriate antibiotics, renal-replacement therapy, and supportive care.

She was successfully removed from the ECMO circuit after 9 days and weaned from the mechanical ventilator 4 days later. She was discharged to an inpatient rehabilitation facility and continued to do well at the 6-month follow-up.