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Difference between revisions of "Diffuse alveolar damage"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Hyaline membranes - very high mag.jpg | |||
| Width = | |||
| Caption = Hyaline membranes. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = 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 | |||
| LMDDx = [[organizing pneumonia]] (especially for ''proliferative phase DAD''), [[bronchiolitis obliterans]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[lung]] - see ''[[diffuse lung diseases]]'' | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| 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]] | |||
| ClinDDx = | |||
| Tx = 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.<ref name=Ref_PCPBoD8_364>{{Ref PCPBoD8|364}}</ref> | |||
Classically, DAD is the histologic correlate of: | |||
*Acute respiratory distress syndrome (ARDS). | |||
**[[AKA]] ''adult respiratory distress syndrome'' (ARDS) to differentiate it from ''[[respiratory distress syndrome]]'' in infants. | |||
*Acute interstitial pneumonia (AIP). | |||
The DDx is broad:<ref>{{Ref WMSP|91}}</ref> | |||
*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''.<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== | |||
Features:<ref name=Ref_Klatt103>{{Ref Klatt|103}}</ref><ref name=pmid16766248>{{Cite journal | last1 = Castro | first1 = CY. | title = ARDS and diffuse alveolar damage: a pathologist's perspective. | journal = Semin Thorac Cardiovasc Surg | volume = 18 | issue = 1 | pages = 13-9 | month = | year = 2006 | doi = 10.1053/j.semtcvs.2006.02.001 | PMID = 16766248 }}</ref> | |||
#Exudative: | |||
#*Hyaline membranes - '''key feature'''. | |||
#**Debris (pink crap) lines the alveolar spaces. | |||
#Proliferative: | |||
#*Interstitial thickening. | |||
#*Inflammation (lymphocytes). | |||
#*Hobnailing of alveolar lining cells (type 2 pneumocyte hyperplasia<ref>URL: [http://d3jonline.tripod.com/20-Pulmonary_II/Pathology_of_Interstitial_Lung_Diseases.htm http://d3jonline.tripod.com/20-Pulmonary_II/Pathology_of_Interstitial_Lung_Diseases.htm]. Accessed on: 22 February 2012.</ref>). | |||
#*Edema (link pink crap in the alveoli). | |||
#*[[Masson bodies]] in the airway. | |||
#*Hyaline material (usu. focal) - '''key feature'''. | |||
#Fibrotic: | |||
#*Interstitial inflammation. | |||
#*Fibrosis. | |||
DDx:<ref name=pmid16766248>{{Cite journal | last1 = Castro | first1 = CY. | title = ARDS and diffuse alveolar damage: a pathologist's perspective. | journal = Semin Thorac Cardiovasc Surg | volume = 18 | issue = 1 | pages = 13-9 | month = | year = 2006 | doi = 10.1053/j.semtcvs.2006.02.001 | PMID = 16766248 }}</ref> | |||
*[[Cryptogenic organizing pneumonia]] - especially for ''proliferative phase DAD''. | |||
*[[Bronchiolitis obliterans]]. | |||
===Images=== | |||
<gallery> | |||
Image:Hyaline membranes - low mag.jpg | Exudative phase DAD - low mag. (WC/Nephron) | |||
Image:Hyaline membranes - intermed mag.jpg | Exudative phase DAD - intermed. mag. (WC/Nephron) | |||
Image:Hyaline membranes - high mag.jpg | Exudative phase DAD - high mag. (WC/Nephron) | |||
Image:Hyaline membranes - very high mag.jpg | Exudative phase DAD - very high mag. (WC/Nephron) | |||
Image:ARDS.jpg | Exudative DAD (WC) | |||
</gallery> | |||
www: | |||
*[http://www.flickr.com/photos/pulmonary_pathology/4710141110/in/photostream/ Proliferative phase DAD - intermed. mag. (flickr.com/Yale Rosen)]. | |||
*[http://www.flickr.com/photos/pulmonary_pathology/4709499629/in/photostream/ Proliferative phase DAD - high mag. (flickr.com/Yale Rosen)]. | |||
==See also== | |||
*[[Diffuse lung diseases]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Diffuse lung diseases]] | |||