diffuser Alveolarschaden

Elevated
plasma levels of Krebs von den Lungen-6 and geographic appearance on high-resolution computed tomography are associated with diffuse alveolar damage in autopsy cases of acute respiratory distress syndrome: a retrospective study. A 70-year-old man, who developed respiratory failure during antibiotic therapy for Staphylococcus aureus bacteremia, was diagnosed with acute respiratory distress syndrome. High-resolution CT at diagnosis showed bilateral diffuse reticulation with geographic appearance (black arrows), well-circumscribed infiltrations partially spared in secondary pulmonary lobule units, and bilateral pleural effusions. Although the patient was placed on mechanical ventilation in addition to being administered antibiotics, he passed away 4 days after diagnosis, and autopsy was performed. Pathological findings of the lungs revealed hyaline membrane formation along dilated alveolar ducts and alveoli, with shrinkage of adjacent alveoli and hyperplasia of type II pneumocytes, representing the exudate phase of diffuse alveolar damage
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Diffuse alveolar damage (DAD) is a common manifestation of drug-induced lung injury that results from necrosis of type II pneumocytes and alveolar endothelial cells.

Clinical presentation

Affected patients present with dyspnea, cough, and occasionally fever. Diffusion capacity of the lung for carbon monoxide is characteristically decreased.

Pathology

Etiology

Drugs that most commonly cause diffuse alveolar damage are bleomycin, busulfan, carmustine (BCNU), cyclophosphamide, melphalan, mitomycin, and gold salts.

Histopathology

Histopathologically, diffuse alveolar damage is divided into an acute exudative phase and a late reparative (proliferative) phase.

  • the exudative phase, which is characterized by alveolar and interstitial edema and hyaline membranes, is most prominent in the 1st week after lung injury.
  • the reparative phase, which is characterized by proliferation of type II pneumocytes and interstitial fibrosis, typically occurs after 1 or 2 weeks.

Depending on the severity of the injury, fibrosis can improve significantly, remain stable, or progress to honeycomb lung.

Radiographic features

Plain radiograph

Chest radiographs show bilateral heterogeneous or homogeneous opacities, often in a mid and lower lung distribution.

Progression to diffuse opacification is common.

CT

High-resolution computed tomography in early diffuse alveolar damage typically shows scattered or diffuse areas of ground-glass opacity.

Fibrosis typically develops within 1 week but initially may not be evident on chest radiographs. However with progressive fibrosis, marked architectural distortion and honeycomb lung can occur.

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Assoziationen und Differentialdiagnosen zu diffuser Alveolarschaden:
Honigwabenlunge
 
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medikamenteninduzierte
Pneumonitis
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