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diffuse alveolar damage

Friday 4 June 2004

Digital case

- JRC:6304 : Diffuse alveolar damage (methotuxate).
- JRC:6305 : Diffuse alveolar damage.

Definition: Diffuse alveolar damage (DAD) is the lesion that underlies and is responsible for the majority of cases of the acute respiratory distress syndrome (ARDS).

DAD can follow a large number of precipitating events including infection, sepsis, trauma, shock, toxic inhalants, drug toxicity, burns and others.

DAD begins with an acute exudative phase characterized by the presence of interstitial and intra-alveolar edema, hyaline membranes and interstitial inflammation.

Resolution of the acute exudative phase may occur. In the absence of resolution there is transition into a proliferative/organizing phase characterized by interstitial and intra-alveolar fibroblastic proliferation.

The mortality rate is high. In those patients who survive there may be restitution of normal lung structure and function. Some survivors develop chronic fibrotic lung disease of varying severity.

Synopsis

- alveolar hyaline membranes

Etiology

- pulmonary infections

  • viral pulmonary infections
  • bacterial pulmonary infections
  • fungal pulmonary infections
  • parasitic pulmonary infections

- toxic inhalants
- drugs
- shock
- dysimmunity
- acute radiation reactions
- acute allergic reactions
- hypersensitivity pneumonitis
- alveolar hemorrage syndromes
- idiopathic

  • acute interstitial pneumonia (Hamman-Rich syndrome)

Links

- Diffuse alveolar damage (DAD) at the Yale Rosen Collection

Videos

- Diffuse alveolar damage by Washington Deceit

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References

- Proliferative activity in fibrosing lung diseases: a comparative study of Ki-67 immunoreactivity in diffuse alveolar damage, bronchiolitis obliterans-organizing pneumonia, and usual interstitial pneumonia. El-Zammar O, Rosenbaum P, Katzenstein AL. Hum Pathol. 2009 Apr 13. PMID: 19368952

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