Bilateral infiltrates and hypoxemia do not automatically mean ARDS.
Cardiogenic pulmonary edema can look similar on chest radiograph, and many critically ill patients have overlapping physiology. The important bedside question is not simply, “What label fits?” The more useful question is, “Which treatable contributors are present right now?”
ARDS is primarily inflammatory lung injury with increased permeability pulmonary edema. The alveolar-capillary barrier is injured, causing protein-rich edema, reduced compliance, shunt physiology, and heterogeneous aeration.