ARDS and Diffuse Alveolar Damage: A Pathologist’s Perspective

Castro, Claudia Y.

doi:10.1053/j.semtcvs.2006.02.001

Cited by 93 publications

(83 citation statements)

References 18 publications

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“…The acute phase (Figure 1) occurs during the first week after the initial insult. The main histological findings seen during this phase are capillary congestion, interstitial and intraalveolar oedema associated with fibrin and formation of hyaline membranes, which are most prominent at 3-7 days [3,4]. Thrombi may develop as a result of localised alterations in the coagulation pathway.…”

Section: Diffuse Alveolar Damagementioning

confidence: 99%

“…Oedema and hyaline membranes are not prominent during this phase [4]. The fibrotic phase is characterised by features of interstitial fibrosis, including alveolar septal thickening from collagen deposition [3].…”

Section: Diffuse Alveolar Damagementioning

confidence: 99%

“…Patients typically present with severe hypoxaemia and require mechanical ventilation [1]. Numerous causes of DAD have been described, including infections, inhalants, drugs, shock, sepsis and radiation [3]. The exact cause of DAD may not be apparent from imaging alone, as the imaging findings of DAD are similar regardless of the cause.…”

Section: Diffuse Alveolar Damagementioning

confidence: 99%

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Acute pulmonary injury: high-resolution CT and histopathological spectrum

Obadina¹,

Torrealba²,

Kanne³

2013

BJR

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Acute lung injury usually causes hypoxaemic respiratory failure and acute respiratory distress syndrome (ARDS). Although diffuse alveolar damage is the hallmark of ARDS, other histopathological patterns of injury, such as acute and fibrinoid organising pneumonia, can be associated with acute respiratory failure. Acute eosinophilic pneumonia can also cause acute hypoxaemic respiratory failure and mimic ARDS. This pictorial essay reviews the high-resolution CT findings of acute lung injury and the correlative histopathological findings.

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Section: Diffuse Alveolar Damagementioning

confidence: 99%

Section: Diffuse Alveolar Damagementioning

confidence: 99%

Section: Diffuse Alveolar Damagementioning

confidence: 99%

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Acute pulmonary injury: high-resolution CT and histopathological spectrum

Obadina¹,

Torrealba²,

Kanne³

2013

BJR

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“…Diffuse alveolar damage (DAD) is a histopathological pattern of lung injury, and is the pathological correlate in most patients with acute respiratory distress syndrome (ARDS) [15][16][17][18]. Early DAD manifests an acute exudative phase that is characterised by interstitial oedema, epithelial necrosis and sloughing, the presence of fibrinous exudates in alveolar air spaces and hyaline membrane formation.…”

mentioning

confidence: 99%

Haemosiderin-laden macrophages in the bronchoalveolar lavage fluid of patients with diffuse alveolar damage

Maldonado

Parambil

Yi³

et al. 2009

Eur Respir J

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Quantification of haemosiderin-laden macrophages in bronchoalveolar lavage fluid (BALF) has been used to diagnose diffuse alveolar haemorrhage (DAH) but has not been assessed in patients with diffuse alveolar damage (DAD).The present study analysed BALF obtained from 21 patients with DAD diagnosed by surgical lung biopsy.The median age of 21 patients with DAD was 68 yrs (range 18-79 yrs); 14 (67%) were male and 12 (57%) were immunocompromised. The median proportion of haemosiderin-laden macrophages in BALF was 5% (range 0-90%), but was o20% in seven (33%) patients, fulfilling the commonly used BALF criterion for DAH. There was a trend toward a positive correlation between the percentage of haemosiderin-laden macrophages in BALF and parenchymal haemorrhage assessed semiquantitatively by histopathological analysis. Patients with o20% haemosiderinladen macrophages in BALF showed a significantly increased mortality rate (p50.047) compared to those with ,20%.In patients with an acute onset of diffuse lung infiltrates and respiratory distress, o20% haemosiderin-laden macrophages in BALF can occur with DAD, and is not necessarily diagnostic of DAH. The finding of o20% haemosiderin-laden macrophages in BALF is associated with a worse prognosis in patients with DAD.

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“…The histologic appearance of this process evolves over the course of the injury from an early exudative or injury phase, through a proliferative or organizing phase, and finally into a healed or resolved phase. 20 The proliferative phase is characterized by alveolar septal thickening from interstitial edema and mild inflammation. Ultrastructural analysis by electron microscopy reveals that this phase is initially characterized by necrosis of type 1 pneumocytes, endothelial cell damage, and sloughing of the alveolar basement membranes.…”

Section: Pathologymentioning

confidence: 99%