Difference between revisions of "Diffuse alveolar damage"

From Libre Pathology
Jump to navigation Jump to search
(tweak)
Line 37: Line 37:
*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.  
Line 50: Line 50:
*Idiopathic.
*Idiopathic.


Note:
Notes:
*DAD may ''not'' be present in all cases that are clinically ''ARDS''.<ref name=pmid23370917>{{cite journal |vauthors=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>
*DAD may ''not'' be present in all cases that are clinically ''ARDS''.<ref name=pmid23370917>{{cite journal |vauthors=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>
*TRALI may have DAD; however, cases are reported without the pattern.<ref name=pmid18673344>{{cite journal |vauthors=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>


==Microscopic==
==Microscopic==

Revision as of 02:16, 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)
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]
  • TRALI may have DAD; however, cases are reported without the pattern.[4]

Microscopic

Features:[5][6]

  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[7]).
    • Edema (link pink crap in the alveoli).
    • Masson bodies in the airway.
    • Hyaline material (usu. focal) - key feature.
  3. Fibrotic:
    • Interstitial inflammation.
    • Fibrosis.

DDx:[6]

Images

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. "Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy". Am J Respir Crit Care Med 187 (7): 761–7. April 2013. doi:10.1164/rccm.201211-1981OC. PMID 23370917.
  4. "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. November 2008. doi:10.1111/j.1537-2995.2008.01879.x. PMID 18673344.
  5. Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 103. ISBN 978-1416002741.
  6. 6.0 6.1 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.
  7. URL: http://d3jonline.tripod.com/20-Pulmonary_II/Pathology_of_Interstitial_Lung_Diseases.htm. Accessed on: 22 February 2012.