Diffuse Alveolar Damage



Diffuse Alveolar Damage


Anna Sienko MD

Timothy C. Allen MD, JD



Diffuse alveolar damage, clinically represented as acute respiratory distress syndrome, can be idiopathic. But it is more often due to other causes that cover an extensive list and can include infection both bacterial and viral, drugs, collagen vascular disease, inhalants/toxins, shock, and pulmonary vasculitis/pulmonary hemorrhage syndromes (Table 16-1). The lung injury, which is acute, shows similar histologic features regardless of the underlying cause or initiating event. Depending on the time interval of the underlying insult and transbronchial biopsy, the histologic features show variable morphology with an early acute phase, an organizing or proliferative phase, and a late fibrotic phase. The early acute phase is seen on biopsy as interstitial and intra-alveolar edema associated with variable hemorrhage and deposits of fibrin with the characteristic hyaline membranes forming several days after injury. Usually a week after injury the hyaline membranes are well formed and seen as eosinophilic fibrinous material of variable thickness, outlining the intra-alveolar spaces. The proliferative phase is seen at this time (usually 7 days after injury) associated with the hyaline membranes, type II pneumocyte hyperplasia, and demonstrates in the interstitium features of organization with formation of fibroblastic foci and associated acute inflammation. Diffuse alveolar damage can regress with treatment; however progression can also occur with fibrosis characterized by cellular infiltrates with proliferation of fibroblasts and deposition of collagen.









Table 16-1 Causes of Diffuse Alveolar Damage


















































































































Shock
    Cardiogenic
    Neurogenic
    Sepsis
Trauma
    Head
    Bone fractures
    Crush injuries
    Lung contusions
    Fat embolism
Infections
    Viral
    Bacterial
    Fungal
Aspiration
    Gastric contents
    Near-drowning
    Hydrocarbons
Drugs
    Chemotherapy
    Penicillamine
    Amiodarone
    Narcotics
    Nitrofurantoin
Pulmonary hemorrhage syndromes
    Wegener granulomatosis
    Polyarteritis nodosa
    Goodpasture syndrome
    Microscopic polyangiitis
Metabolic disorders
    Uremia
    Pancreatitis
Inhalation injury
    Oxygen
    Smoke
    Numerous toxic chemicals, fumes, and gases
Hematologic disorders
    Transfusion-associated lung injury
    Cardiopulmonary bypass
    Disseminated intravascular coagulation
Collagen vascular diseases
    Rheumatoid arthritis
    Scleroderma
    Systemic lupus erythematosus
    Polymyositis/dermatomyositis
    Mixed connective tissue disease
Idiopathic
    Acute interstitial pneumonia (Hamman-Rich syndrome)
Others
    Toxic shock syndrome
    Intravenous administration of contrast material
    Gestational trophoblastic disease
    Heat
    Radiation
    High altitude
    Burns

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Oct 10, 2016 | Posted by in GENERAL | Comments Off on Diffuse Alveolar Damage

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