Difference between revisions of "Diffuse alveolar damage"

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| Endoscopy  =
| Endoscopy  =
| Prognosis  = often poor, dependent on severity and comorbidities
| Prognosis  = often poor, dependent on severity and comorbidities
| Other      = histologic correlate of: acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), transfusion related acute lung injury (TRALI)  
| Other      = histologic correlate of: acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), transfusion related acute lung injury (TRALI); may be seen in chronic [[interstitial lung disease]] - esp. [[IPF]]
| ClinDDx    =  
| ClinDDx    =  
| Tx        = dependent on underlying cause
| Tx        = dependent on underlying cause
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*Abrupt hypoxemia with pulmonary infiltrates leading to epithelial cell and endothelial cell death not accompanied by cardiac failure.<ref name=Ref_PCPBoD8_364>{{Ref PCPBoD8|364}}</ref>
*Abrupt hypoxemia with pulmonary infiltrates leading to epithelial cell and endothelial cell death not accompanied by cardiac failure.<ref name=Ref_PCPBoD8_364>{{Ref PCPBoD8|364}}</ref>


DAD is the histologic correlate of:  
Classically, DAD is the histologic correlate of:  
*Acute respiratory distress syndrome (ARDS).
*Acute respiratory distress syndrome (ARDS).
**[[AKA]] adult respiratory distress syndrome (ARDS) to differentiate it from ''[[respiratory distress syndrome]]'' in infants.  
**[[AKA]] ''adult respiratory distress syndrome'' (ARDS) to differentiate it from ''[[respiratory distress syndrome]]'' in infants.  
*Acute interstitial pneumonia (AIP).  
*Acute interstitial pneumonia (AIP).  
*Transfusion related acute lung injury (TRALI).


The DDx is broad:<ref>{{Ref WMSP|91}}</ref>
The DDx is broad:<ref>{{Ref WMSP|91}}</ref>
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*Inflammatory.
*Inflammatory.
*Idiopathic.
*Idiopathic.
Notes:
*DAD may ''not'' be present in all cases that are clinically ''ARDS''.<ref name=pmid23370917>{{cite journal |authors=Thille AW, Esteban A, Fernández-Segoviano P, Rodriguez JM, Aramburu JA, Peñuelas O, Cortés-Puch I, Cardinal-Fernández P, Lorente JA, Frutos-Vivar F |title=Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy |journal=Am J Respir Crit Care Med |volume=187 |issue=7 |pages=761–7 |date=April 2013 |pmid=23370917 |doi=10.1164/rccm.201211-1981OC |url=}}</ref>
*Transfusion related acute lung injury (TRALI) may have DAD; however, cases are reported without the pattern.<ref name=pmid18673344>{{cite journal |authors=Danielson C, Benjamin RJ, Mangano MM, Mills CJ, Waxman DA |title=Pulmonary pathology of rapidly fatal transfusion-related acute lung injury reveals minimal evidence of diffuse alveolar damage or alveolar granulocyte infiltration |journal=Transfusion |volume=48 |issue=11 |pages=2401–8 |date=November 2008 |pmid=18673344 |doi=10.1111/j.1537-2995.2008.01879.x |url=}}</ref>
*DAD may be seen in acute exacerbations of chronic [[interstitial lung disease]], e.g. idiopathic pulmonary fibrosis.<ref name=pmid21637367>{{cite journal |authors=Kaarteenaho R, Kinnula VL |title=Diffuse alveolar damage: a common phenomenon in progressive interstitial lung disorders |journal=Pulm Med |volume=2011 |issue= |pages=531302 |date=2011 |pmid=21637367 |pmc=3099744 |doi=10.1155/2011/531302 |url=}}</ref>


==Microscopic==
==Microscopic==

Latest revision as of 02:24, 19 July 2021

Diffuse alveolar damage
Diagnosis in short

Hyaline membranes. H&E stain.
LM dependent on phase - exudative: hyaline membranes; proliferative: interstitial thickening, inflammation (lymphocytes), type 2 pneumocyte hyperplasia, edema, Masson bodies in the airway, hyaline material (usu. focal); fibrotic: interstitial inflammation, interstitial fibrosis
Subtypes exudative, proliferative, fibrotic
LM DDx organizing pneumonia (especially for proliferative phase DAD), bronchiolitis obliterans
Site lung - see diffuse lung diseases
Prognosis often poor, dependent on severity and comorbidities
Other histologic correlate of: acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), transfusion related acute lung injury (TRALI); may be seen in chronic interstitial lung disease - esp. IPF
Treatment dependent on underlying cause

Diffuse alveolar damage, abbreviated DAD, is a relatively common lung pathology that is grouped with the diffuse lung diseases and has several clinical correlates.

General

Etiology:

  • Abrupt hypoxemia with pulmonary infiltrates leading to epithelial cell and endothelial cell death not accompanied by cardiac failure.[1]

Classically, DAD is the histologic correlate of:

  • Acute respiratory distress syndrome (ARDS).
  • Acute interstitial pneumonia (AIP).

The DDx is broad:[2]

  • Infection/sepsis.
  • Toxic (smoke, oxygen).
  • Drug (amiodarone, chemotherapy).
  • Trauma/shock.
  • Inflammatory.
  • Idiopathic.

Notes:

  • DAD may not be present in all cases that are clinically ARDS.[3]
  • Transfusion related acute lung injury (TRALI) may have DAD; however, cases are reported without the pattern.[4]
  • DAD may be seen in acute exacerbations of chronic interstitial lung disease, e.g. idiopathic pulmonary fibrosis.[5]

Microscopic

Features:[6][7]

  1. Exudative:
    • Hyaline membranes - key feature.
      • Debris (pink crap) lines the alveolar spaces.
  2. Proliferative:
    • Interstitial thickening.
    • Inflammation (lymphocytes).
    • Hobnailing of alveolar lining cells (type 2 pneumocyte hyperplasia[8]).
    • Edema (link pink crap in the alveoli).
    • Masson bodies in the airway.
    • Hyaline material (usu. focal) - key feature.
  3. Fibrotic:
    • Interstitial inflammation.
    • Fibrosis.

DDx:[7]

Images

  • Exudative phase DAD - low mag. (WC/Nephron)

  • Exudative phase DAD - intermed. mag. (WC/Nephron)

  • Exudative phase DAD - high mag. (WC/Nephron)

  • Exudative phase DAD - very high mag. (WC/Nephron)

  • Exudative DAD (WC)

www:

See also

References

  1. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 364. ISBN 978-1416054542.
  2. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 91. ISBN 978-0781765275.
  3. ↑ Thille AW, Esteban A, Fernández-Segoviano P, Rodriguez JM, Aramburu JA, Peñuelas O, Cortés-Puch I, Cardinal-Fernández P, Lorente JA, Frutos-Vivar F (April 2013). "Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy". Am J Respir Crit Care Med 187 (7): 761–7. doi:10.1164/rccm.201211-1981OC. PMID 23370917.
  4. ↑ Danielson C, Benjamin RJ, Mangano MM, Mills CJ, Waxman DA (November 2008). "Pulmonary pathology of rapidly fatal transfusion-related acute lung injury reveals minimal evidence of diffuse alveolar damage or alveolar granulocyte infiltration". Transfusion 48 (11): 2401–8. doi:10.1111/j.1537-2995.2008.01879.x. PMID 18673344.
  5. ↑ Kaarteenaho R, Kinnula VL (2011). "Diffuse alveolar damage: a common phenomenon in progressive interstitial lung disorders". Pulm Med 2011: 531302. doi:10.1155/2011/531302. PMC 3099744. PMID 21637367. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099744/.
  6. ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 103. ISBN 978-1416002741.
  7. ↑ 7.0 7.1 Castro, CY. (2006). "ARDS and diffuse alveolar damage: a pathologist's perspective.". Semin Thorac Cardiovasc Surg 18 (1): 13-9. doi:10.1053/j.semtcvs.2006.02.001. PMID 16766248.
  8. ↑ URL: http://d3jonline.tripod.com/20-Pulmonary_II/Pathology_of_Interstitial_Lung_Diseases.htm. Accessed on: 22 February 2012.
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