Diffuse alveolar damage
Diffuse alveolar damage | |
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Micrograph showing hyaline membranes, the key histologic feature of diffuse alveolar damage. H&E stain. | |
Specialty | Respirology |
Diffuse alveolar damage (DAD) is a histologic term used to describe specific changes that occur to the structure of the lungs during injury or disease. Most often DAD is described in association with the early stages of acute respiratory distress syndrome (ARDS).[1] It is important to note that DAD can be seen in situations other than ARDS (such as acute interstitial pneumonia) and that ARDS can occur without DAD[1].
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] For example, diffuse alveolar damage has been reported in the lungs of individuals dying from COVID-19.[3]
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).[4]
Prevalence
It is a common biopsy finding.[5] Through histology, diffuse alveolar damage goes through several stages:
- Exudative phase - similar to pulmonary edema. The alveoli become flooded with exudate
- Hyaline membrane production. Hyaline membranes are fibrinous structures resulting from organization of the exudate.
- Organising phase
References
- ^ a b Cardinal-Fernández, Pablo; Lorente, José A.; Ballén-Barragán, Aída; Matute-Bello, Gustavo (2017-06). "Acute Respiratory Distress Syndrome and Diffuse Alveolar Damage. New Insights on a Complex Relationship". Annals of the American Thoracic Society. 14 (6): 844–850. doi:10.1513/AnnalsATS.201609-728PS. ISSN 2329-6933.
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(help) - ^ 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.
- ^ Barton L, Duval E, Stroberg E, Ghosh S, Mukhopadhyay S (April 2020). "COVID-19 autopsies, Oklahoma, USA". American Journal of Clinical Pathology. doi:10.1093/ajcp/aqaa062. PMID 32275742.
- ^ 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.
- ^ 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.