Diffuse alveolar damage

Diffuse alveolar damage is a histological pattern in lung disease. It is seen in acute respiratory distress syndrome (ARDS),[1] transfusion related acute lung injury (TRALI) and acute interstitial pneumonia (AIP).

Diffuse alveolar damage
Micrograph showing hyaline membranes, the key histologic feature of diffuse alveolar damage. H&E stain.
SpecialtyRespirology

Cause

Diffuse alveolar damage is associated primarily with ARDS and TRALI in adults, and hyaline membrane disease in neonates. It is most commonly associated with infection.[2]

Diagnosis

Diagnosis of ARDS is based on clinical manifestation and its severity is evaluated with ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FIO2).[3]

Prevalence

It is a common biopsy finding.[4] Through histology, diffuse alveolar damage goes through several stages:

  1. Exudative phase - similar to pulmonary edema. The alveoli become flooded with exudate
  2. Hyaline membrane production. Hyaline membranes are fibrinous structures resulting from organization of the exudate.
  3. Organising phase

References
  1. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. p. 715. ISBN 978-0-7216-0187-8.
  2. Parambil JG, Myers JL, Aubry MC, Ryu JH (July 2007). "Causes and prognosis of diffuse alveolar damage diagnosed on surgical lung biopsy". Chest. 132 (1): 50–7. doi:10.1378/chest.07-0104. PMID 17475632.
  3. ARDS Definition Task Force; Ranieri, V. M.; Rubenfeld, G. D.; Thompson, B. T.; Ferguson, N. D.; Caldwell, E.; Fan, E.; Camporota, L.; Slutsky, A. S. (20 June 2012). "Acute Respiratory Distress Syndrome". JAMA. 307 (23): 2526–33. doi:10.1001/jama.2012.5669. PMC 3408735. PMID 22797452.
  4. Parambil JG, Myers JL, Ryu JH (August 2006). "Diffuse alveolar damage: uncommon manifestation of pulmonary involvement in patients with connective tissue diseases". Chest. 130 (2): 553–8. doi:10.1378/chest.130.2.553. PMID 16899858.



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