Pathological Spectrum of the Lung in Cases of Violent Death: Part II. Clinicopathologic Correlation

Abstract

The correlation between the type of pathological lesion of the lung and the circumstances which encompass their evolution in 66 cases of violent death have been examined. Pulmonary lesions have been classified into four groups. 1. Inflammatory alveolar lesions without a diffuse interstitial involvement (IAL) which result from direct aggressions in subjects of advanced age. 2. Inflammatory alveolar lesions with a diffuse interstitial affection (IALW) which are more frequent in younger subjects having a higher defense capacity and with severe lesions requiring admission to an intensive care unit. 3. Edemohemorrhagic lesions (EHL) appearing as a precocious lesion at any age. 4. Unspecific chronic lesions (UCL) previous to the aggression and without any relationship to death. The most obvious feature noted was the frequent occurrence of certain types of acute pulmonary lesions indicative of the rapid and extensive capacity of the lung to react to a lesion agent even when death follows rapidly after the aggression. The scarcity of acute interstitial lesions among the older group can be related to a diminution of biological defense activity leading to a less vigorous response; on the contrary, diffuse lesions of the wall seem to be related to an excess of defense mechanisms, determined more by age, severity of lesion, and type of medical assistance received than by a specific type of aggression.

Diffuse Alveolar Damage of the Lungs in Forensic Autopsies: Assessment of Histopathological Stages and Causes of Death

“…HM development manifests 4-5 days after damage [ 27 ]. In forensic autopsies, Ferrer et al [ 3 ] detected HM development in 12% of exudative-phase cases and 62% of proliferative-phase cases. In our study, the prevalence of HM occurrence was higher in the proliferative phase than in the exudative phase.…”

“…DAD manifests clinically as acute respiratory distress syndrome (ARDS). It can be seen in sepsis, shock, trauma, severe ARDS, and idiopathic cases with undetected aetiological factors as well as acute exacerbations of chronic interstitial lung diseases [ 1 – 3 ]. While diffuse bilateral opacity is observed on lung radiology, many cases display deep hypoxemia that requires mechanical ventilation; the mortality rate is 43–50% [ 4 , 5 ].…”