In our study, there was one patient with bilateral lobar consolidations, which progressed into ARDS. Other investigators (3) also reported similar radiographic features in patients who progressed into ARDS. Although extensive consolidations in the lung might be severe manifestations of primary viral pneumonia from the pandemic H1N1 2009 influenza virus infection, there still remains the possibility of combined pneumonia caused by other pathogens or pulmonary manifestations of ARDS (14) .