A 63-year-old man was admitted to intensive care unit due to acute respiratory distress syndrome (ARDS). During treatment of lymphoma, he developed bacterial pneumonia. Several days later, severe ARDS was developed; his PaO2/FiO2 (P/F) ratio was about 80. He was intubated and managed with airway pressure release ventilation (APRV) of 27 cmH2O high positive end expiratory pressure (PEEP). CT scan was performed to evaluate lung lesions, 5 days later.