Dynamic Chest Radiography Promising for Diagnosis of Wheezing-Related Respiratory Failure: Case Reports

The report, published in Radiology Case Reports, describes how DCR was used effectively in four diverse clinical scenarios, offering real-time functional insights that shaped clinical decision-making.

The case series was led by Dr. Hidemitsu Miyatake and colleagues from the Department of Emergency and Critical Care Medicine at Shiga University of Medical Science in Japan. The team explored DCR as a complementary technique performed directly at the bedside using a portable X-ray system equipped with DCR capabilities.

According to the researchers, this approach allowed clinicians to obtain dynamic respiratory information immediately after standard chest radiographs—especially valuable when initial images offered limited diagnostic clues.

DCR is a relatively new low-dose imaging technology that captures sequential X-ray frames—up to 15 per second—over a brief breathing cycle or breath-hold. These images are then processed to generate ventilation maps and visualize real-time respiratory motion. Its portability and short acquisition time make it particularly suitable for emergency and critical care settings where rapid, noninvasive assessment is essential.

To demonstrate DCR’s clinical utility, the authors presented four cases involving acute respiratory failure accompanied by wheezing: presumed asthma exacerbation, tracheobronchomalacia, cardiogenic pulmonary edema, and endotracheal mucus plugging.

One illustrative case involved an 81-year-old woman with no known history of asthma who developed sudden wheezing and hypoxemia after undergoing transcatheter aortic valve implantation. Her initial portable chest X-ray showed a mildly enlarged cardiac silhouette but no obvious lung congestion. However, bedside DCR revealed increased translucency during inspiration and reduced pixel-value fluctuations throughout both lungs, pointing to widespread airflow limitation and bronchospasm. The patient experienced rapid improvement following bronchodilator therapy, and follow-up DCR confirmed recovery of ventilation. The episode was ultimately diagnosed as an acute asthma exacerbation based on the combined clinical and imaging findings.

The remaining cases each demonstrated the value of DCR in uncovering functional abnormalities. In a patient with suspected tracheobronchomalacia, DCR identified expiratory collapse of the central airway. In another case, it supported a diagnosis of cardiogenic pulmonary edema by showing signs of congestion without loss of ventilation. A fourth patient, who was intubated, showed unilateral ventilation impairment attributable to mucus plugging—information not evident on standard radiographs.

While the authors emphasized that DCR is not intended to replace CT, bronchoscopy, or conventional chest radiography, they noted that it can provide critical, supplemental dynamic information when routine tests are inconclusive. The ability to perform DCR immediately after ordinary X-rays, without moving critically ill patients, is a key advantage.

Based on these cases, the research team concluded that DCR may be a valuable adjunct for evaluating wheezing-related respiratory failure, helping clinicians better understand underlying pathophysiology and make more informed decisions at the bedside.

Reference:

Miyatake, H., Toshimitu, M., Nakano, S., Shimizu, J., Tsujita, Y., Asada, K., & Shiomi, N. (2026). Dynamic chest radiography for wheezing-associated acute respiratory failure: 4 case reports. Radiology Case Reports, 21(2), 514-520. https://doi.org/10.1016/j.radcr.2025.10.012