Medicine of the Future in America

Respiratory Failure and Death Following Acute Inhalation: Pathology (1)

The combined lung weights ranged from 2,100 to 3,100 g. All cases were similar grossly: airless, firm, and expanded with small amounts of hemorrhagic mucus present. The histologic picture varied in accordance to how long each patient survived after insult. Case 4, who died 11 days after insult, had pulmonary changes of early acute lung injury characterized by slight pneumocyte hyperplasia, hyaline membrane formation, and foci of fibrosis (Fig 4). The fibrotic areas were predominantly arranged in edematous intersti-tium. A mild interstitial mononuclear infiltrate was also present. Case 3, who died 15 days after insult, revealed a similar picture; however, there were fewer hyaline membranes and the fibrous areas were increased in size and appeared more mature and less edematous. Additionally, emphysema was present. antibiotics levaquin

Case 2, who died 22 days after insult, had pulmonary changes consistent with a late stage of acute lung injury. There was marked pneumocyte hyperplasia and a significant decrease in the air spaces that were replaced with extensive fibrosis. Congestion and alveolar hemorrhage were prominent. Mild emphysematous changes were also present. Case 1, who died 24 days after insult, had changes of end stage acute lung injury (Fig 5). There was almost total obliteration of the alveolar spaces with extensive mature interstitial fibrosis. The remaining alveolar spaces were filled with inflammatory cells, hyperplastic pneumocytes, and hemosiderophages. Congestion was prominent.


Figure 4. Histologic section of lung demonstrating mild interstitial fibrosis, hyaline membranes, and congestion (hematoxylin-eosin, original magnification x 6.6).


Figure 5. Histologic section of lung demonstrating marked interstitial fibrosis and obliteration of alveolar airspace (hematoxylin-eosin, original magnification X 10).

This entry was posted in Pulmonary function and tagged adult respiratory distress syndrome, arterial blood gases, chelation therapy, chest roentgenograms, lung injury.
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