Context.—
Acute pulmonary injury may occur as a result of myriad direct or indirect pulmonary insults, often resulting in hypoxemic respiratory failure and clinical acute respiratory distress syndrome. Histologically, most patients will exhibit diffuse alveolar damage on biopsy, but other histologic patterns may be encountered, such as acute eosinophilic pneumonia, acute fibrinous and organizing pneumonia, and diffuse alveolar hemorrhage with capillaritis.
Objective.—
To review the diagnostic features of various histologic patterns associated with a clinical picture of acute lung injury, and to discuss key features in the differential diagnosis.
Data Sources.—
The review is drawn from pertinent peer-reviewed literature and the personal experience of the authors.
Conclusions.—
Acute pulmonary injury is a significant cause of morbidity and mortality. In addition to diffuse alveolar damage, pathologists should be aware of alternate histologic patterns of lung disease that may present with a similar clinical presentation because this may impact treatment decisions and disease outcome.
Gross examination is fundamental to the practice of surgical pathology. Accurate diagnosis can often be made based on the classic gross appearance of a lung lesion. On the other hand, inaccurate diagnosis or wrong tumor staging is unavoidable if lesions are missed, unrecognized, or inadequately sampled. Different grossing techniques should be used for grossing neoplastic and nonneoplastic lung specimens.
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