Difference between revisions of "Diffuse alveolar damage"

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#redirect [[Diffuse_lung_diseases#Diffuse_alveolar_damage]]
'''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>
 
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).
*Transfusion related acute lung injury (TRALI).
 
The DDx is broad:<ref>{{Ref WMSP|91}}</ref>
*Infection/sepsis.
*Toxic (smoke, oxygen).
*Drug (amiodarone, chemotherapy).
*Trauma/shock.
*Inflammatory.
*Idiopathic.
 
==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]]

Revision as of 12:53, 18 April 2014

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]

DAD is the histologic correlate of:

  • Acute respiratory distress syndrome (ARDS).
  • Acute interstitial pneumonia (AIP).
  • Transfusion related acute lung injury (TRALI).

The DDx is broad:[2]

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

Microscopic

Features:[3][4]

  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[5]).
    • Edema (link pink crap in the alveoli).
    • Masson bodies in the airway.
    • Hyaline material (usu. focal) - key feature.
  3. Fibrotic:
    • Interstitial inflammation.
    • Fibrosis.

DDx:[4]

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. ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 103. ISBN 978-1416002741.
  4. ↑ 4.0 4.1 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.
  5. ↑ URL: http://d3jonline.tripod.com/20-Pulmonary_II/Pathology_of_Interstitial_Lung_Diseases.htm. Accessed on: 22 February 2012.
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