The PaC02 rose to 70 mm Hg despite the administration of theophylline and methylprednisolone (1,000 mg/day). The patient returned to the ICU on the 34th day after admission for intubation and mechanical ventilation. Her condition deteriorated, with marked airway resistance and poor responsiveness to oxygen administration, and she died on the 60th day after admission.
At autopsy the right lung weighed 370 g, and the left lung weighed 290 g. Both lungs were soft, light, and voluminous. It was impossible to pour formaldehyde solution (Formalin) into many segments (left SI + 2, 4a, 5a, 6, 8, 9, 10a, and 10c and right Sla, 2, 3a, 4, 6, 7, 8, 9, 10a, and 10c), because of proximal obstructions situated in the third to fifth branches, numbering from each lobar bronchus.
Histologic examination of the sites of obstruction showed loss of the bronchial epithelium, which was replaced by fibrous granulation tissue, while the continuity of the elastic lamina and the submucosal structures of the bronchial wall was maintained (Fig 2). Inflammatory cell infiltration into the obliterated bronchi was only mild. Several areas of membranous obliteration of the bronchi were also recognized (Fig 3). Scattered areas of bronchiolar obliteration were seen as well, without any associated findings of bronchiolitis obliterans with organizing pneumonia. Shallow ulcers were diflusely seen on the tongue, larynx, and tracheal mucosa. ventolin inhalers
Figure 2. Obstruction of large bronchus by fibrous scar tissue. Luminal space is totally replaced by fibrous tissue. Other bronchial mucosal components, such as elastic fiber layer (arrow), smooth muscle layer, and cartilage, are preserved (EVG, original magnification x 120).
Figure 3. Membranous obliteration of large bronchus. Proximal part (right lumen) preserves almost normal mucosal structure. On the other hand, distal part (left lumen) exhibits narrowing of lumen and proliferation of granulation tissue on luminal surface (arrow) (HE, original magnification x 40).