C. Hoelz et al., Morphometric differences in pulmonary lesions in primary and secondary ARDS - A preliminary study in autopsies, PATH RES PR, 197(8), 2001, pp. 521-530
The present study was undertaken in order to describe the morphological dif
ferences between pulmonary lesions in acute respiratory distress syndrome o
riginating from direct pulmonary injury (ARDSp) and those originating from
extrapulmonary injury (ARDSexp).
We investigated a total of 38 ARDS-patients (27 males) ran-inc, in age from
19 to 75 years, classified according to underlying disease in pulmonary (A
RDSp) and extrapulmonary disease (ARDSexp). The extent of acute diffuse alv
eolar damage was assessed morphometrically on histologic gross sections in
the upper and lower lobes of one lung.
The lesions showed quantitative differences in extent and distribution acco
rding to underlying disease (primary pulmonary or secondary involvement).
In pulmonary ARDS, a predominance of alveolar collapse (16.6% +/- 12.3% ver
sus 10.3% +/- 11.9%, p = 0,03), fibrinous exudate (1.7% +/- 3.2% versus 0.4
% +/- 1.1%, p = 0.01) and alveolar wall edema (11.2% +/- 7.4% versus 6.6% /- 4.4%, p = 0,05) were found compared to extrapulmonary ARDS.
We conclude that the morphology of acute diffuse alveolar damage (DAD) is m
ainly determined by underlying disease (pulmonary ARDS or extrapulmonary AR
DS) differing in quantitative terms within the lung. Physiological, radiogr
aphic and respiratory system mechanics differences described in ARDSp and A
RDSexp may therefore be due to morphometric differences in pulmonary lesion
s.